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Our experience with caustic oesophageal burn in south of Iran
Seyed M V Hosseini1, Babak Sabet, Sakineh Falahi
1Department of Surgery, Division of Paediatric Surgery, Shiraz University of Medical Sciences, Hormozgan University of Medical Sciences, Shiraz, Iran.
Insights
Alkaline esophageal burns in children treated with early gastrostomy and small stents showed better recovery. This approach prevents malnutrition and promotes healing, reducing complications from caustic injuries.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Trauma Surgery
Background:
- Alkaline esophageal burns (EB) are a severe injury common in Southern Iran due to accidental ingestion of cleaning liquids.
- This condition is particularly prevalent among children in the region.
Purpose of the Study:
- To document clinical experiences and outcomes of managing caustic esophageal injuries in pediatric patients.
- To evaluate the efficacy of different treatment strategies for alkaline esophageal burns.
Main Methods:
- A before-and-after clinical trial was conducted involving 35 children with alkaline esophageal burns from November 2006 to 2009.
- Patients underwent flexible endoscopy, received steroids, antibiotics, and H2 blockers, followed by rigid esophagoscopy for stent insertion in Grade IIb or higher burns.
Main Results:
- Fifteen patients (Grade IIb) treated with early large stents (8 weeks) experienced significant complications, including fistulas, contractures, and three deaths.
- Conversely, 4 out of 10 patients (Grade IIb) with small stents (6 months) and early gastrostomy recovered well with minimal complications, requiring intermittent dilatation.
Conclusions:
- Early gastrostomy is crucial for preventing malnutrition in pediatric patients with esophageal burns.
- Small-sized stents are better tolerated long-term, facilitating continuous esophageal lavage and promoting healing.
Context:
The alkaline oesophageal burn (EB) is a very debilitating injury and common in the southern rural area of Iran, where the air conditioning systems are cleaned with an alkaline liquid, which is accidentally ingested by children.
Aims:
The aim is to share our experiences with caustic injury in children.
Settings And Design:
A 'before' and 'after' clinical trial.
Materials And Methods:
From November 2006-2009, 35 cases of alkaline burns were referred to our center. All underwent flexible endoscopy and thereafter received steroid, antibiotic and H2 blocker. They subsequently underwent rigid oesophagoscopy, with grade IIb or higher burns, for inserting the two different kinds of stents.
Results:
Four out of 10 (GIIa <) underwent dilatation occasionally. Fifteen (GIIb) with early large stent (eight weeks) developed complications (three antral contractures, one oesophagotracheal fistula, one tracheobronchial fistula, three perforations, three deaths, and the remaining cases had not undergone dilatation yet. Four out of 10 with (GIIb), who had small stents (Six months) and early gastrostomy needed dilatation every four to six weeks and all recovered, with no significant complications.
Conclusions:
Early use of gastrostomy prevents malnutrition in patients. Small size stents are much more tolerable for a prolonged time are not obstructed by saliva that washes the wall of the damaged oesophagus continuously and promotes healing.
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