Corrosion injury of the upper gastrointestinal tract after swallowing strong alkali

Corrosive injury to the GI tract in adults: a practical approach

Corrosive injury to the GI tract still poses great challenges with regards to the initial evaluation triage, as well as the optimization of medical management. Although relatively uncommon in the adult population, these injuries can cause significant morbidity and serious sequelae of complications, such as esophageal strictures and cancer. Prompt recognition of the process and aggressive measures towards the stabilization of the patient are key to a favorable outcome.

Corrosive injury of the oesophagus in children

OBJECTIVE

This study examined a cohort of pediatric patients treated for suspected corrosive injury of the oesophagus in the ENT department between 1994 and 2003.

METHODS

During the study period we examined 337 patients. All patients were treated according to an individual diagnostico-therapeutic protocol that included: foremost, early rigid oesophagoscopy; intensive medical therapy; nasogastric tube placement; and/or surgical intervention.

RESULTS

Our proposed system of grading on a scale from 0 to 4 was used to classify the findings upon oesophagoscopy. One hundred eighty eight patients (55.7%) had a negative exam; 1st degree corrosive injury was present in 58 patients (17.4%); 2nd and 3rd degree injury in 81 patients (24%); and 4th degree was found in 10 patients (3%).

CONCLUSIONS

Because the endoscopic findings were positive in 44% of patients with suspected corrosive injury, early rigid oesophagoscopy is indicated in all patients suspected of having corrosive injury even in the absence of clinical symptoms.

Pediatric dyspnea caused by supraglottic stenosis: a rare complication of alkali corrosive injury

Acquired supraglottic stenosis is a rare, but potential late sequela of corrosive injury, usually occurring 1 to 2 months after the initial trauma. The presentation may be delayed in children and is potentially lethal. We describe two pediatric patients, aged 31 and 16 months, who developed progressive inspiratory stridor and hoarseness about 2 months after accidental alkali ingestion. Fiberoptic laryngoscopy showed supraglottic stenosis. Intubation was achieved with a very small endotracheal tube under fiberoptic laryngobronchoscopic guidance prior to general anesthesia. Both patients successfully underwent CO(2) laser treatment under direct laryngoscopic guidance. There has been no case of recurrence reported after 1 year of follow-up other than a thin membranous scar in one case at the 3rd month of follow-up, which was easily dealt with by bronchoscopy dilatation. For such patients, monthly laryngoscopic examinations are advisable after alkaline corrosive injury for a minimum of 6 months. Prompt diagnosis and early airway intervention can reduce the need for tracheostomy and decrease the mortality rate.

Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy

BACKGROUND

Upper endoscopy provides information that can be used to predict complications and to facilitate clinical decisions for patients who have ingested corrosive substances. The role of EUS in corrosive injury has not been investigated. The aim of this study was to determine whether concurrent catheter-probe EUS provides additional information that predicts complications after corrosive injury.

METHODS

Eighteen patients were referred (from 1997 to 2003) for EGD and concurrent EUS within 24 hours after ingestion of a caustic agent. Two patients were excluded (1 pneumoperitoneum, 1 markedly swollen cricoarytenoid cartilage/epiglottis). The severity of injury in the different segments of the esophagus and stomach was graded (0, 1, 2a, 2b, 3a, 3b) by endoscopy and by EUS (0, M, SM, MP, SS). The development of complications during hospitalization and 3-month follow-up were recorded.

OBSERVATIONS

All 16 patients underwent EGD with EUS without complication. The frequency of early and late complications increased as the endoscopic and the EUS severity grades increased. The accuracy of prediction of bleeding or stricture was 100% when endoscopic grade 3a was used as a cutoff. For EUS, the highest accuracy was observed in the prediction of bleeding (75%) and stricture (100%) when EUS grade MP was used as a cutoff.

CONCLUSIONS

EUS can be performed safely within 24 hours of ingestive of corrosive substances. However, when used in conjunction with conventional endoscopic observation, it does not increase the accuracy for prediction of early or late complications. Standard endoscopy alone is sufficient for evaluation and prediction of bleeding and stricture complications after corrosive injury in the upper-GI tract.