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[Severity of ingestion of caustic substance in children]
T Lamireau1, B Llanas, C Deprez
1Service d'urgences pédiatriques, CHU Pellegrin, Bordeaux, France.
Insights
Caustic ingestion in children can cause severe esophageal strictures. Early endoscopic evaluation is crucial for classifying injury severity and guiding treatment to prevent long-term complications.
Area of Science:
- Pediatric Gastroenterology
- Toxicology
- Emergency Medicine
Context:
- Caustic ingestion is a significant cause of esophageal injury in children.
- Accidental ingestion often occurs in domestic settings.
- Esophageal stricture formation is a serious sequela requiring medical intervention.
Purpose:
- To evaluate the correlation between initial endoscopic findings and the nature of ingested caustic substances.
- To assess the clinical presentation and outcomes of pediatric patients following caustic ingestion.
- To determine the incidence of esophageal stricture formation and associated risk factors.
Summary:
- A study of 65 children with caustic ingestion revealed that while many had no or minimal endoscopic lesions, a significant portion (26%) developed severe injuries.
- Ingestion of household chemicals, particularly liquids, was common.
- Severe injuries were associated with symptoms like hematemesis and respiratory distress, and 8 of 17 children in the severe group developed esophageal strictures, necessitating aggressive treatment.
Impact:
- Highlights the persistent risk of esophageal stricture after pediatric caustic ingestion.
- Emphasizes the need for prompt endoscopic assessment to guide management.
- Underscores the importance of preventative measures against accidental caustic ingestions in children.
Background:
Caustic ingestion is frequent in children, sometimes leading to esophageal stricture.
Patients And Methods:
Between 1988 and 1994, esogastroscopy was performed in 65 children after caustic ingestion. The children were classified in three groups: no lesion (group A), minimal lesions (group B) and severe lesions (group C). Nature of the caustic substance, clinical signs and evolution were compared in the three groups.
Results:
Median age was 2 years for the 65 children (24 girls, 41 boys). Ingestion occurred at home (94%) during meal periods. Substances were dishwater detergents (n = 14), oven cleaner (n = 10), bleach (n = 9), washing powder (n = 4), others (n = 20), more often in a liquid form (n = 37) than solid (n = 28). Children had no symptoms (57%), presented emesis (n = 20) or abdominal pain (n = 10) not correlated to endoscopic findings, and hematemesis (n = 3) or respiratory distress (n = 4), both symptoms seen only in group C. Buccal lesions (41%) were not correlated to endoscopic findings. After endoscopy, 28 children (43%) were classified into group A and 20 children (31%) in group B. Among the 17 children (26%) of the group C, eight developed an esophageal stricture: seven long strictures requiring replacement of the esophagus, one short stricture requiring repeated dilations.
Conclusion:
Esophageal stricture is still a severe complication after caustic ingestion. These data stress the interest of controlled studies to confirm the preventive role of high dose corticosteroids, and the importance of the prevention of accidental caustic ingestions in children.