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Published on: April 28, 2020
[Accidental caustic ingestion in Tunisian child. Study of 330 cases]
Jalel Chemli1, Jihen Bouguila, Abdelaziz Harbi
1Service de pédiotrie du CHU Sahloul.
Insights
Caustic ingestion in children frequently causes severe esophageal and gastric lesions. Corticosteroid treatment for severe esophagitis showed a trend towards reduced esophageal stenosis compared to antibiotics.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Clinical Medicine
Context:
- Retrospective study of 330 pediatric caustic product ingestion cases over eight years (1993-2000).
- Analysis of patient demographics, ingested substances, and endoscopic findings.
- Evaluation of treatment protocols for severe esophagitis.
Purpose:
- To analyze the epidemiological and clinical features of caustic product ingestion in children.
- To compare the efficacy of two treatment protocols for severe esophagitis in preventing esophageal stenosis.
- To assess the long-term outcomes of pediatric caustic ingestion.
Summary:
- Caustic ingestion, predominantly bleach and caustic soda, resulted in oeso-gastric lesions in 89% of pediatric cases.
- Severe esophagitis (Stage III) and associated gastric lesions occurred in 11.2% and 15.1% of cases, respectively.
- Corticosteroid treatment for severe esophagitis showed a trend towards fewer stenosis cases compared to antibiotic treatment.
Impact:
- Highlights the significant risk of severe gastrointestinal injury from common household products in children.
- Suggests corticosteroids may be more effective than antibiotics in preventing esophageal stenosis after severe caustic ingestion.
- Informs clinical management strategies and emphasizes the need for preventative measures against pediatric caustic ingestion.
Abstract:
We studied retrospectively 330 cases of caustic product ingestion at the child collected in the pediatric department of Sousse (CHU Sahloul and CHU Farhat Hached) during eight years (1993-2000). It is about 194 boys and 136 girls (sex-ratio to 1.42/1) aged of 4 months at 14 years (middle age at 3 years and 5 months). Concerned products are dominated by the water of bleach (55.7%) dilute essentially (49%), caustic soda (27.9%), diluent of painting (8.5%), potash (2.7%) and the acidic products (2.2%). Endoscopy showed oeso-gastric lesions in 89% of cases: oesophagitis stage I (73.5%), stage IIa (11%), stage IIb (4%), stage III (11.2%) and an inflammatory sténose case of straightaway. The associated gastric lesions have been found in 15.1% of the cases. The recovery was the rule for all patient presenting a benign oesophagitis. The 46 cases of severe oesophogitis have been treated according two protocols: --A group (n=1 ), treated by parenteral food with treatment by antibiotics (1993-1994). --B group (n=35), treated by high dose of corticosteroids (Méthyl-prednisolone) aiming to warn esophageal sténosis (1995-2000). Three patients of the A group and five of the B group developed stenosis with statistically meaningful difference (p=0.44). Among these eight patients, six required oesophagoplasty and two had a good evolution after esophageal dilation.
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