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At least 19 recordsLinked to original sources

PubMed1988

Progressive roentgenographic appearance of caustic esophagitis.

We observed progressive roentgenographic changes in five patients who had caustic esophagitis after accidental ingestion of a liquid alkali. Initial endoscopic examination showed moderate caustic esophagitis in all patients, and esophageal atony and poor distension were early roentgenographic observations. Esophageal strictures developed 13 to 44 days after caustic ingestion in all patients. Intramural pseudodiverticula complicated stricture formation in two patients. Esophageal diverticula developed in two cases, three months to one year after caustic ingestion. In summary, moderate caustic esophagitis is associated with esophageal dilatation, atony, and peristaltic abnormalities initially, and with eventual stricture formation.

Adult↗

PubMed1991

Caustic burns of the upper digestive and respiratory tracts.

In a series of 51 children presenting with an accidental caustic burn, symptoms were analysed for their predictive value of significant i.e. necrotizing oesophageal lesions (grade II or III). For the whole group, the incidence of significant oesophageal lesions was 37%. Vomiting and/or respiratory distress were associated with high incidence of significant oesophageal burn (84% and 75% respectively). The particular location of each caustic burn was analysed for its association with caustic burns at other anatomical sites. Of the 18 patients with a laryngeal burn, 72% also had a grade II or III oesophageal burn. The 19 patients with a grade II or III oesophageal burn and the 18 patients with a laryngeal burn, all had lesions at other sites. In the group of 19 patients with a caustic lesion limited to one site, only 1 patient showed mild oesophagitis (grade I) without late sequelae.

Burns, Chemical↗

PubMed1992

Conservative treatment of caustic esophageal strictures in children.

The most common cause of esophageal stricture in children is the accidental ingestion of strong corrosive agents. During a 13-year period between 1976 and 1989, 202 patients were diagnosed as having caustic esophageal strictures at the Hacettepe University Children's Hospital Department of Pediatric Surgery. A retrospective clinical study was performed to find out the place and predictors of a successful outcome for conservative treatment in children who have caustic esophageal strictures. Two hundred two children, of whom 145 were male (71.7%) and 57 female (28.3%) with 168 (83.2%) being younger than 6 years of age, were evaluated retrospectively. Whereas only 49.3% of patients could be treated within a 12-month period, 50.7% needed more than 1 year, 32.9% needed more than 2 years, 26.7% needed more than 3 years, and 15.4% needed more than 4 years of periodic dilations in order to become swallowers through native esophaguses. The success of conservative treatment has been higher in patients younger than 8 years of age, and in strictures due to caustics other than lye involving upper third portion and less than five cm of an esophageal segment. Most caustic esophageal strictures could have been treated by conservative measures in children.

Burns, Chemical↗

PubMed1990

Caustic strictures of the oesophagus.

Ingestion of caustic material is a major management problem which occurs most commonly in children. Twenty-five patients with caustic ingestion seen over a ten-year period are reported. Twelve patients had severe burns, resulting in oesophageal strictures. Of these, ten were children below six years of age (median age, 3 years). Dysphagia and vomiting were the main presenting features. Oropharyngeal burn was present in 83% of patients with oesophageal burns. The strictures involved the entire oesophagus in two patients, the upper third in four, the mid oesophagus in two and the lower third in four. Periodic dilatations were successful in restoring an adequate lumen in 7 patients with short strictures. Five patients required surgery. There was one death. Caustic damage to the oesophagus is preventable. Education of the public and simple measures by manufacturers of caustics are urgently needed.

Accidents, Home↗

PubMedDate not supplied

[The problem of caustic poisoning in children].

The exposure to caustic substances in childhood, being accidental in most cases, can cause doubts in the initial diagnostic therapeutic approach; the risk of missing lesions following caustic ingestion when symptoms are scarce or lacking is high. The paper provides an overview of the physiopathology and clinical presentation of caustic injuries and stress the possibility of burns of esophagus and/or stomach even without oropharyngeal symptoms and/or signs. The esophagogastroduodenoscopy has now an essential role in the evaluation of gastrointestinal tract injury, as a guide to the therapy and as a prognostic criterion. So it is possible to reduce the risk of poor outcomes by the appropriate treatment. Anyway the primary prevention against the exposition to caustic substances at home is fundamental and must be effected both through active and passive measures.

Adolescent↗

PubMed1990

Experimental studies on caustic burns of the stomach by aggressive chemicals.

The treatment of caustic burns of the stomach in childhood by acids, alkalis and especially soldering fluids has remained without any clear concept so far. Surgical treatment consists of therapy of acute complications or late sequelae. Early endoscopy enables one to decide between conservative treatment and early laparotomy. Animal experiments were performed in albino rats for the development of a therapeutic concept. Because of its amphoteric and aggressive nature, soldering fluid zinc dissolved in 33-50 M saline) was used as the caustic substance. Clear demarcation and tissue changes can be recognized after 6-8 h, at the earliest. Laparotomy aiming at protective plication or atypical gastric resection should be performed at that time, if endoscopy reveals a third-degree caustic burn of the stomach.

Animals↗

PubMed1989

Caustic esophageal lesions in childhood: prevention of stricture formation.

Accidental caustic ingestion, a problem of childhood, can lead to esophageal stricture formation. We studied 132 children less than 19 years of age who were admitted to our hospital for suspected caustic ingestion. Forty-nine had burns in the esophagus, 11 of whom had deep and circular burns and were therefore prone to developing esophageal strictures. Only these 11 children were treated for prevention of stricture formation with a special nasogastric tube, functioning as intraluminal stent; this was their sole treatment. No corticosteroids were used. Only one of the 11 developed mild stenosis. In none of the other untreated children was stricture formation observed. Therefore, we believe that this approach spares many children unnecessary treatment and hospitalization, that our nasogastric tube effectively prevents stricture formation, and that there is no need for the use of corticosteroids in the treatment of caustic esophageal lesions in childhood.

Adolescent↗

PubMedDate not supplied

Foreign body and caustic ingestion: management 1979.

Most physicians involved in the diagnosis and management of foreign body aspiration and caustic ingestion assume that the numbers of these cases are decreasing. A sizeable number of patients die of caustic ingestion and poisoning annually, and deaths from foreign body ingestion have more than doubled since 1950. Increasing the significance of these needless tragedies is the fact that the most frequent victim is a young, healthy child. Physicians should encourage educational campaigns to alert parents to the dangers of caustic agents and small items capable of being aspirated. They should be conversant with the treatment of both. This paper reviews current opinions regarding management.

Airway Obstruction↗

PubMed1992

Caustic ingestion injuries of the upper aerodigestive tract.

Few reports have described in detail the injuries that occur to the oral cavity, pharynx, and larynx following caustic ingestion. The role of dynamic radiographic studies to delineate the extent of damage has been minimized. In-depth radiographic analysis of such cases has not, to our knowledge, been previously reported. In order to examine the injuries and functional abnormalities of these sites following caustic ingestion, the records of The Johns Hopkins Swallowing Center were reviewed. Five patients were identified as having significant upper aerodigestive tract caustic injuries. All patients had dysphagia, epiglottis injuries, and incomplete laryngeal protection with aspiration. Four of five had sustained some degree of esophageal stenosis. Also noted were pharyngeal muscle dysfunction, nasopharyngeal regurgitation, tongue fixation, and hypopharyngeal stenosis. Roentgenographic findings are described and illustrated. The multidisciplinary approach to the management and rehabilitation of these patients is discussed.

Adult↗

PubMed1989

Comparison of titratable acid/alkaline reserve and pH in potentially caustic household products.

Exposure to caustic agents is a common problem, affecting thousands of individuals annually. Despite this incidence, the factors responsible for the production of injury remain poorly defined. Although extremes of pH seem to correlate well with the production of esophageal lesions, pH alone fails to explain the damage resulting from exposure to agents with near neutral pH, such as soldering flux containing zinc chloride. We determined titratable acid/alkaline reserve (TAR) in 38 potentially caustic household agents. A subset of these products was evaluated in an in-vitro canine esophageal model to determine whether TAR correlated with esophageal injury. The results indicate that for the products evaluated TAR correlated better than pH with the production of caustic esophageal injury.

Animals↗

PubMedDate not supplied

[Esophago-gastric lesions caused by caustics].

A wide range of lesions may occurs after accidental or voluntary ingestion of caustic substances including mild epithelial injury to whole thickness necrosis of the involved organs. The type of management varies according to the severity of the damage, medical therapy being indicated in the less severe cases while surgery is required in life threatering lesins or alternatively as elective treatment of trighly desabling sequelae last complications such as. From 1981 to 1989 we observed 20 patients with acute hastro-oesophageal lesions due to ingestion caustic substances 19 of then were successfully treated with medical therapy. Only 1 patient underwent surgery and died of oesophagus cardiac fistula with right atrium perforation (24 days following total gastrectomy). Based on either our own experience and the data reported in the literature we believe that the most adequate management of patients with lesions of the E.G. due to caustic agents tract must include: vital functions control maintenance intensive care treatment of shock endoscopic monitoring of E.G. lesions emergency surgical treatment where needed.

Adolescent↗

PubMed1992

[Caustic esophagitis in children].

Treatment of caustic ingestion in children is a difficult and controversial problem which has not yet to be resolved. Here we report the evolution of fourteen children with esophageal injury after caustic ingestion that were treated with steroids at high-doses, nasogastric intubation and antibiotics. An early esophagoscopy was performed in all patients. Four patients developed esophageal strictures, three of which were mild and subsequent dilatation was successful. Only one patient was referred to surgery. We think that although it cannot be established, the use of high-dose of steroids and nasogastric intubation may be helpful for children with caustic esophagitis. We conclude that early endoscopy is useful to evaluate the severity of the lesions and to establish the necessity for treatment.

Anti-Bacterial Agents↗

PubMed1990

[Accidental ingestion of caustics in Tunisian children. Report of 125 cases].

The authors reviewed 125 cases of accidental ingestion of caustic substances admitted to a general pediatrics department over the last four years. L'eau de Javel (bleaching agent with sodium hypochloride) was the most frequently encountered caustic substance (89%). Esophagogastric fibroscopy was performed in 100 cases and esophageal lesions were classified according to tree grades of severity. In 46 cases, fibroscopy was normal, while severe esophagogastric lesions (grades 2 and 3) were found in 26 cases. On follow-up, six patients developed esophageal stricture, three of them after concentrated, eau de Javel ingestion. Stricture was severe in four cases, and required colonoplasty of the esophagus; it was limited in two cases and required endoscopic dilatation only. The authors emphasize the frequency and the severity of lesions caused by chloride bleach (eau de Javel) and recommend that fibroscopy be carried out in all children following ingestion of any caustic substance, even in the absence of oropharyngeal burns.

Burns, Chemical↗

PubMed1990

[Caustic burns of the stomach secondary to ingestion of acid in infants: importance of fibro-endoscopy].

Two cases of corrosive burns of the stomach after the ingestion of acid by children are presented. Both patients were the same sex and of a similar age (19 and 20 months). The chemical nature of the caustic substance ingested (hydrochloric acid) and the lack of initial symptoms were also similar. The clinical diagnosis however, was completely different due to the endoscopic finding of serious gastric lesions in one of the patients which were then treated accordingly. In children, the accidental ingestion of caustic acids is often accompanied by few clinical symptoms initially. This can lead to failure to diagnose correctly when symptoms are correlated with the existence and severity of digestive lesions. When a caustic substance has been ingested, in addition to symptoms, consideration of the acidity or alkalinity of the ingested product is also an important parametre in evaluating endoscopic findings.

Burns, Chemical↗

PubMed1989

[Immediate oesojejunal anastomosis after total gastrectomy in caustic necrosis].

Eight patients underwent total gastrectomy for caustic ingestion. Oesophago-jejunostomy was performed in the same surgical session. One patient died from hemorrhage. Only one of the 7 survivors had a benign anastomotic fistula. Five healed without any sequelae, 2 underwent colonoplasty 3 months later, because of a secondary oesophageal stenosis. We conclude that it is feasible, in certain unusual cases, to restore gastrointestinal continuity after total gastrectomy for caustic necrosis: moderate oesophageal lesions (stage I or II) and ingestion of a caustic product that cause few oesophageal damage (acids, liquid chlorine bleach, ...).

Adolescent↗

PubMed1989

[Does the ingestion of caustics produce irreversible motor changes in the esophagus? Manometric study of 17 cases].

During the acute period of caustic esophagitis, important alterations in esophageal motor function appear. However, it is not known if these alterations persist later. To determine whether motor disorders persist (after the aggression) in the esophagus that has suffered caustic aggression, a manometric study was made in two groups of patients classified as mild (9 cases) or severe esophagitis (8 cases), and results were compared with those of a control group. Patients who had developed stenosis or suffered the caustic aggression less than a year earlier were excluded. The probable existence of motor anomalies could determine the appearance of dysphagia or reduce the effectiveness of motor clearance of the esophageal body, thus conditioning a situation of esophageal defenselessness against physiological or eventual abnormal episodes of gastroesophageal reflux (RGE). Our results indicate that in a variable percentage of cases some peristaltic dysfunctions can persist in the esophageal body in relation to the severity of the initial lesion.

Adolescent↗

PubMed1992

[Caustic stenosis of the esophagus in Libreville. Results of the surgical treatment].

41 cases of caustic stenosis of the oesophagus were treated surgically by the thoracic and visceral surgical teams of La Fodation Jeanne Ebori and L'Hopital Pédiatrique d'Owendo in Libreville. The lesions were due to bleach ingestion in 38 cases, caustic soda in 2 cases and sulfuric acid in 1 case. Ingestion was an accident in 29 cases and voluntary in 12. There were 32 men and 9 women. Among them, there were 32 infants and 9 adults. The mean age was 4.5 years for the infants and 25 years for the adults. The surgical procedures were gastrostomy, followed by dilatations of the stenosis in 19 cases, esophagoplasty using the stomach, with pyloroplasty and jejunostomy in 4 cases, and gastrostomy associated with esophagoplasty using the colon in 18 cases. Mortality rate was 2.4%. It was about 1 patient, from general causes. Cervical or thoracic fistulae occurred in 4 patients, all of them successfully treated by medical means, and 3 patients had regressive pulmonary infections. The mean follow-up was 4 years, with good results. The authors suggest a surgical attitude in the management of caustic stenosis, every time the medical management is unsuccessfull.

Adolescent↗

PubMed1990

[Role of endoscopy in caustic gastroesophageal lesions].

From 1984 to 1989 we have examined endoscopically 191 patients who ingested, for different causes, some type of caustic substance. The mean age was 36.8 +/- 21 years. 57% were female and 43% males. The most common substance was lye (52%). The clinical symptoms consisted mainly of epigastric pain and odynophagia. The most prevalent lesion was oesophagitis, of variable degrees (58%). Complications related to the ingestion of the caustic appeared in 20% of the patients; three of them died. The most common sequela was oesophageal stenosis and secondly gastric stenosis. Males ingested acids more frequently than females (P less than 0.001). In 20% of the cases the ingestion of the caustic was for suicide while in children all the cases were accidents.

Accidents↗