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Caustic burns of the upper digestive and respiratory tracts
P Vergauwen1, D Moulin, J P Buts
1Department of Intensive Care, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium.
Insights
Vomiting or respiratory distress in children with caustic burns strongly predict severe esophageal damage. Laryngeal burns also frequently indicate serious esophageal injury, highlighting the need for thorough assessment in pediatric caustic ingestions.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Otolaryngology
Background:
- Accidental caustic burns in children can lead to severe esophageal injury.
- Early identification of significant esophageal lesions is crucial for timely intervention.
Purpose of the Study:
- To evaluate the predictive value of clinical symptoms and burn location for significant necrotizing esophageal lesions (grade II or III) in children with accidental caustic burns.
- To determine the association between burns at specific anatomical sites and concurrent esophageal involvement.
Main Methods:
- Retrospective analysis of 51 children with accidental caustic burns.
- Assessment of clinical symptoms (vomiting, respiratory distress) and burn location (larynx, esophagus).
- Correlation of symptoms and burn location with the severity of esophageal lesions (grade II or III).
Main Results:
- 37% of children presented with significant esophageal lesions (grade II or III).
- Vomiting (84%) and respiratory distress (75%) were highly predictive of significant esophageal burns.
- Laryngeal burns were present in 18 patients, with 72% having grade II or III esophageal burns.
- Patients with grade II or III esophageal burns or laryngeal burns invariably had lesions at other sites.
- Only one patient with a single-site caustic lesion had mild esophagitis (grade I) without sequelae.
Conclusions:
- Clinical symptoms like vomiting and respiratory distress are critical indicators of severe esophageal injury in pediatric caustic burns.
- The presence of a laryngeal burn warrants a high suspicion for significant esophageal involvement.
- Caustic burns are frequently multifocal, and isolated lesions are rare, emphasizing the importance of a comprehensive examination.
Abstract:
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.