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[Accidental ingestion of caustics in children. Apropos of 100 cases]
A Dabadie1, M Roussey, M Oummal
1Service de Pédiatrie-Génétique Médicale, C.H.U. Pontchaillou, Rennes.
Insights
Early fiberoptic endoscopy is effective for diagnosing caustic ingestion injuries in children. Severe injuries, particularly from dairy pipeline cleaners, require aggressive management including parenteral nutrition and surgical intervention.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Toxicology
Context:
- Caustic ingestion poses a significant risk to children, necessitating prompt and accurate diagnosis.
- Fiberoptic endoscopy is a key diagnostic tool for evaluating the severity of upper gastrointestinal tract injuries.
- The study period spans from January 1985 to June 1988, reflecting historical data on caustic ingestion management.
Purpose:
- To evaluate the efficacy of early fiberoptic endoscopy in diagnosing caustic ingestion injuries in pediatric patients.
- To classify the severity of esophageal and gastric burns based on endoscopic findings.
- To assess the outcomes and management strategies for children with varying degrees of caustic injury.
Summary:
- One hundred children with caustic ingestion underwent early fiberoptic endoscopy, with 96 cases performed without general anesthesia.
- Endoscopic findings ranged from normal to severe necrosis (grade 3), with a higher incidence of severe burns associated with farm products.
- Most children were discharged after examination, but severe injuries (grade 2 and 3) required prolonged hospitalization, parenteral nutrition, and surgical interventions such as antrectomy.
Impact:
- Highlights the diagnostic value of fiberoptic endoscopy in pediatric caustic ingestion, enabling timely and appropriate treatment.
- Emphasizes the severe consequences of ingesting certain substances, like dairy pipeline cleaners, and the need for specialized care.
- Underscores the critical role of total parenteral nutrition and surgical management in favorable outcomes for severe caustic injuries.
Abstract:
One hundred children (67 boys, 33 girls) underwent early fiberoptic endoscopy (without general anesthesia in 96 cases) for caustic ingestion between January 1985 and June 1988. The intended use of the product was household (83) industrial (4) farm (6) or medicinal (7). Caustic burns were classified as grade 1 (mucosal hyperaemia), grade 2 (ulceration) and grade 3 (necrosis). Endoscopy was negative in 52, grade 1 in 41 who had evidence of esophagitis and/or gastritis, grade 2 and/or grade 3 in 7 cases, 4 of whom had ingested farm products. Eighty-seven children were discharged after examination, 6 were hospitalized for 24 hours. Outcome was favorable for the 5 cases with grade 2 lesions after total parenteral nutrition for an average period of 79 days. The 2 cases with grade 3 injuries went on to develop an esophageal stricture requiring endoscopic dilation and an antral stricture which was treated by antrectomy. Authors emphasize the severity of lesions secondary to the ingestion of dairy pipeline cleaners, the advantages of fiberoptic endoscopy and the role of parenteral nutrition.