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[Caustic burns of the esophagus in childhood. Our 14 years' experience]
F García Merino1, A Martínez Caro, C García Vallés
1Departamento de Cirugía Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla.
Insights
Caustic ingestion in children, primarily bleach, often affects toddlers. While bleach rarely causes severe esophageal damage, lye can lead to significant lesions, necessitating careful evaluation and treatment.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Otolaryngology
Context:
- Retrospective analysis of 3,600 children treated for caustic agent ingestion between 1972 and 1986.
- Focus on hospital admissions, common agents, and presenting symptoms.
- Identifies a predominance of cases in the 1-3 year age group.
Purpose:
- To review the clinical presentation, management, and outcomes of pediatric caustic ingestions.
- To differentiate the severity of lesions caused by different caustic agents.
- To establish guidelines for diagnostic and therapeutic interventions.
Summary:
- Lye ingestion resulted in more severe esophageal lesions compared to household bleach.
- Oropharyngeal lesions (85%) were the most common symptom, followed by vomiting (26%) and sialorrhea (20%).
- Esophagoscopy is recommended for evaluating esophageal damage, and esophageal dilatations are effective for treating scarring-induced stenosis.
Impact:
- Household bleach ingestion, without significant symptoms beyond vomiting, may not require esophagoscopy.
- Corticosteroid use in the acute phase was associated with a 22% rate of esophageal stenosis in affected children.
- Highlights the importance of prompt diagnosis and appropriate management to prevent long-term complications from caustic ingestions.
Abstract:
A 14-years revision (1972-1986) is made of 3,600 children attended to after ingesting some type of caustic agent. Only 81 were admitted to hospital. We found a predominance in the 1-3 year age group. Bleach was the caustic most frequently present but lye accounted for most major lesions. The more relevant symptoms were oropharyngeal lesions (85%), vomiting (26%) and sialorrhea (20%). Oropharyngeal burns was the sign most often found in esophageal lesions (45%). The ingestion of ordinary household bleach did not result in serious esophageal lesions nor posterior complications, and does not require esophagoscopy if no other symptom except vomiting is present. Esophagoscopy is the ideal means for evaluating esophageal lesions, as are esophageal dilatations with Rehbein dilators for stenosis due to scarring. With the use of corticosteroids in the acute phase, there were 8 cases (22%) of esophageal stenosis out of 36 with lesions.