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Caustic ingestion and its sequelae in children
Insights
Caustic ingestion in children can lead to severe esophageal strictures. Lye-based substances cause the most injury, and early management does not prevent strictures in full-thickness burns, often necessitating esophageal replacement.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Surgical Outcomes
Background:
- Caustic ingestion in children presents a spectrum of esophageal injury, from asymptomatic cases to severe strictures.
- Effective management strategies are crucial for mitigating long-term sequelae.
Purpose of the Study:
- To evaluate the outcomes of caustic ingestion in pediatric patients.
- To identify determinants of esophageal injury severity and long-term management strategies.
Main Methods:
- Retrospective review of 56 pediatric cases (10 months to 5 years) treated between 1973 and 1984.
- Initial management included endoscopy, steroids, and antibiotics.
- Surgical interventions such as dilation and esophageal replacement were analyzed.
Main Results:
- Esophageal burns were confirmed in 37 patients (66%), with 21 (57%) developing strictures.
- Seven patients with limited strictures were successfully treated with dilation.
- Fourteen patients with multiple strictures required esophageal replacement (substernal right colonic interposition) with satisfactory outcomes.
Conclusions:
- The nature of the ingested caustic material, particularly lye, is the primary determinant of esophageal injury severity.
- Full-thickness esophageal injury carries a high risk of stricture formation, irrespective of initial management.
- Multiple esophageal strictures are often refractory to dilation, making early consideration of esophageal replacement essential.
Abstract:
Management of caustic ingestion in children remains a difficult challenge, with the outcome ranging from an asymptomatic state to intractable esophageal strictures. We reviewed the cases of 56 children ranging in age from 10 months to 5 years treated from 1973 to 1984 at the University of Florida. For children seen primarily at our institution, initial management consisted of prompt endoscopy and early institution of steroids and antibiotics. Esophageal burns were confirmed in 37 patients, 21 (56.75%) of whom subsequently had esophageal strictures of varying severity. In seven patients, limited esophageal strictures were managed successfully by dilation, but 14 children with multiple strictures required eventual esophageal replacement. Substernal right colonic interposition was tolerated well by these patients, with few complications, and their growth and development have been satisfactory over follow-up periods ranging from nine months to 13 years. A review of these cases suggests that the character of the ingested caustic material is the most important determinant of the severity of esophageal injury, with preparations containing lye being the most injurious; that in the presence of full-thickness esophageal injury, there is a high potential for stricture formation, regardless of the type of initial management, including early use of steroids; and that multiple esophageal strictures are refractory to dilation, and esophageal replacement should be an early consideration.