PubMed · 6236041
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A A Fisher. 1984. Ethylene oxide dermatitis.. https://pubmed.ncbi.nlm.nih.gov/6236041/
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Oesophageal strictures developing after caustic ingestion in children are a serious problem, and several protocols to prevent stricture formation have been proposed. A prospective clinical trial was conducted for preventing strictures in caustic oesophageal burns in a single clinic, and the results are presented. All children with caustic ingestion who had oesophagoscopy for diagnosing the severity of the burn were included in the study. Eighty-one children were included in the series, with ages ranging between 3 months and 12 years. The patients were given nothing by mouth until oesophagoscopy. IV fluids, broad-spectrum antibiotics, ranitidine, and a single-dose steroid were given. Oral burns were positive in 66 patients. Oesophagoscopy revealed a normal oesophagus in nine patients, grade 1 burn in 24, grade 2a in 21, grade 2b in 23, grade 3a in two, and grade 3b in one. Patients with grade 1 and 2a burns were discharged after oesophagoscopy. Patients with grade 2b and all grade 3 burns were given nothing by mouth for a week except water when swallowing their saliva, and were fed via total parenteral nutrition. After the 1st week, if there was no problem with swallowing, liquid foods were introduced. No intraluminal tubes were used. At the end of the 3rd week, a barium meal was administered and an upper gastrointestinal series taken. Dilatation was performed at 2-week intervals for strictures, which developed in one grade 2a patient, six grade 2b patients, and the grade 3b patient. Only one of these patients is currently on an oesophageal dilatation program. Limiting oral intake and avoiding foreign bodies in the oesophagus seem to provide a good success rate; however, further prospective studies are needed to decrease the incidence of corrosive oesophageal strictures.
Batteries represent less than 2% of foreign bodies ingested by children, but in the last 2 decades, the frequency has continuously increased. Most ingestions have an uneventful course, but those that lodge in the esophagus can lead to serious complications and even death. Medline was used to search the English medical literature, combining "button battery" and "esophageal burn" as keywords. Cases were studied for type, size, and source of the batteries; duration and location of the battery impaction in the esophagus; symptoms; damage caused by the battery; and outcome. Nineteen cases of esophageal damage have been reported since 1979. Batteries less than 15 mm in diameter almost never lodged in the esophagus. Only 3% of button batteries were larger than 20 mm but were responsible for the severe esophageal injuries in this series. These data suggest that manufacturers should replace large batteries with smaller ones and thus eliminate most of the complications. When the battery remains in the esophagus, endoscopic examination and removal done urgently will allow assessment of the esophageal damage, and treatment can be tailored accordingly. There is a need for more public education about the dangers of battery ingestion; this information should be included as part of the routine guidelines for childproofing the home.