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Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries
Sandro Contini1, Alim Swarray-Deen, Carmelo Scarpignato
1Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100, Parma, Italy. sandro.contini@unipr.it
Insights
Accidental ingestion of corrosive substances causes significant childhood injury, particularly in developing nations. Late presentation of esophageal strictures leads to difficult treatments and high recurrence rates, highlighting the need for early intervention and parental education.
Area of Science:
- Pediatric Surgery
- Public Health
- Gastroenterology
Background:
- Unsafe environments contribute to child injuries, with corrosive substance ingestion being a significant, underreported issue in developing countries.
- Late esophageal strictures resulting from caustic ingestion are often severe, influenced by parental knowledge, living conditions, and chemical accessibility.
- Lack of preventive measures is a primary risk factor for these injuries.
Purpose of the Study:
- To address the unmet medical need of corrosive substance ingestion in children.
- To develop a management flowchart for corrosive esophageal strictures based on literature review and field experience in Sierra Leone.
Main Methods:
- A humanitarian program was initiated in Sierra Leone to manage pediatric corrosive ingestion.
- Literature from developing countries and local clinical experience informed the development of a management flowchart.
- Retrospective analysis of 148 patients treated for corrosive esophageal strictures.
Main Results:
- Only 19.5% of patients presented with timely admission.
- Gastrostomy was required for 62.1% of patients, with 42.8% experiencing recurrent strictures.
- Perforation and mortality rates were 5.6% and 4%, respectively.
Conclusions:
- Delayed diagnosis of esophageal caustic strictures in children complicates treatment and increases recurrence.
- Gastrostomy is crucial for nutritional support, necessitating training for caregivers in feeding techniques.
- Successful management hinges on improving nutritional status and maintaining long-term esophageal patency.
Problem:
An unsafe environment is a risk factor for child injury and violence. Among those injuries that are caused by an unsafe environment, the accidental ingestion of corrosive substances is significant, especially in developing countries where it is generally underreported.
Approach:
To address this challenging, unmet medical need, we started a humanitarian programme in Sierra Leone. By reviewing the current literature from developing countries and our own experience in the field, we developed a flowchart for management of this clinical condition.
Local Setting:
This injury is underreported in developing countries. Data available are heavily skewed towards well-resourced centres and do not reflect the entire reality of the condition. Late oesophageal strictures are usually severe. Parent's lack of knowledge, crowded living conditions and availability of chemicals in and around houses account for most ingestions. The widespread lack of any preventive measures represents the strongest risk factor.
Relevant Changes:
Timely admission was observed in 19.5% of 148 patients studied. A gastrostomy was performed on 62.1% of patients, 42.8% had recurrent strictures and 19% are still on a continuous dilatation programme. Perforation and death rate were respectively 5.6% and 4%.
Lessons Learned:
The majority of oesophageal caustic strictures in children are observed late, when dilatation procedures are likely to be more difficult and carry a significantly higher recurrence rate. Gastrostomy is necessary to maintain adequate nutritional status but mothers need training in feeding techniques. Both improvement in nutritional status and sustained oesophageal patency should be the reference points to a successful dilatation.
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