Presentation and management outcome of childhood corrosive oesophageal injury in Benin City

Abstract

Background: Corrosive ingestion in children occurs usually at home and frequently results in debilitating strictures. Prevention and early intervention programs are very important for good outcomes. Aims and Objectives: This study aims at examining the immediate causative factors and problems of this subset of patients with a special focus on treatment and outcome. This study was to audit the management of patients in the paediatric age group who presented for treatment with history and sequelae of corrosive ingestion seen by the cardiothoracic unit of the University of Benin Teaching Hospital from January 2005 till December 2018. Materials and Methods: This is a 14year retrospective study of patients that presented with oesophageal burn injuries from ingestion of corrosive agents to the Cardiothoracic Unit at the University of Benin Teaching Hospital between January 2005 and December 2018. Essentially the first 5years were retrospectively included but the subsequent years were prospective. All available medical data on these patients were retrieved and studied for epidemiological, clinical and operative procedures and outcome. Results: A total of 49 patients were seen and admitted during the period under review. Male (29) : Female (20) ratio was 1:1.4 Mean age was 4.7±4.8 years with a range of 1-16years, The males presented earlier and had worse strictures as well as more surgical procedures. Caustic soda preparations ingested more (93.9%), all ingestions were within the household setting, and all had first aid given by way of oral palm oil. Only two (4.1%) ingested acids with only one flat battery ingestion. 45.5% of the patients had dilatation only and of these 50% recovered after 3 sessions and required no more sessions. A further 50% were lost to follow up. 38.8% had oesophageal replacement with colon following oesophagectomy. Conclusion: In conclusion, corrosive oesophageal stricture is a debilitating disease in children and affects males more, but it is treatable by multiple dilatations and oesophageal replacement with colon. Prevention should be actively pursued as well as early intervention.

Endoscopic Grading as a Predictor to Develop Strictures in Corrosive Esophagitis in Children

“…The preponderance of alkalis in reported pediatric data [ 4 , 8 , 9 , 10 , 18 , 19 , 20 , 21 ] can be explained very easily. Most accidental ingestion happens at home with chemicals found in different households.…”

“…All children undertook upper endoscopy within 24 h of their hospital admission. The esophageal injuries were graded using Zagar endoscopic classification [ 9 , 12 , 13 ] scale ( Table 1 ).…”

“…This kind of necrosis leads to the destruction of esophageal mucosa within a few minutes. Next days after the alkali consumption, mucosal injury is worsened by small vessel thrombosis, bacterial invasion, collagen deposition and ulcer production [ 8 , 9 ]. During this period, there is a high risk of perforation.…”

“…However, in cases of acidic substances, the esophagus can be spared while the stomach is severely injured. The esophageal protective eschar and lower surface tension allow acids to bypass the esophagus [ 8 , 9 , 10 ]. The injury depends on the concentration, quantity, type, and time of contact between chemical substances and the esophagus and pH value.…”

“…Endoscopic grading of corrosive esophagitis, using Zargar endoscopic classification, holds prognostic [ 9 ]. The grade of the injury, determined during the first endoscopic examination, is an important predictor for strictures.…”