Caustic ingestion injuries of the upper aerodigestive tract

Experience in reconstruction of esophagus, epiglottis, and upper trachea due to caustic injuries in pediatric patients and establishment of algorithm

BACKGROUND

Unintentional swallowing of corrosive agents cause problems in the pediatric population. Swallowing dysfunction can be seen after injuring the pharynx and/or epiglottis which leads to the obstruction of esophagus. An algorithm was established taking into account the injury to the epiglottis and restoring gastrointestinal continuity with isolated or combine free and or supercharged jejunum flap, or supercharged colon transposition flap.

METHODS

Seventeen patients between the ages of 3 and 16 (mean age: 7.7) were treated between 1985 and 2019. Three different procedures were performed based on endoscopic findings; for patients with no or minimal damage to epiglottis, pedicled colon transposition was done in 12 cases. For patients with epiglottic scarring or edema, a two-stage reconstruction was performed. In the first stage, free jejunum flap was implemented to the pharynx to facilitate food passage, followed by a pedicled jejunum in two cases, or a pedicled colon transposition in two cases to provide gastrointestinal continuity. For one patient with severe epiglottic scarring, a free jejunal flap was used as a diversion conduit in the first stage, followed by supercharged colon transposition to restore gastrointestinal continuity.

RESULTS

Supercharged intestinal flaps were harvested with 3-4 cm of extra intestinal tissue than the measured thoracic portion in each individual in order to reach the hypopharyngeal region. The size of the free jejunal flaps were 10 cm. Oral feeding was initiated on the eighth postoperative day. Partial loss of the anterior wall of the jejunal flap was seen in one case, in which a free anterolateral thigh-vastus lateralis musculocutaneous flap was used for reconstruction. The mean follow-up time was 5.1 years and there was no stricture in the final outcome.

CONCLUSION

A competent epiglottis is essential for proper swallowing reflex. Meticulous microsurgical dissection and performing supercharged intestinal flaps provide a complication-free end result.

Swallowing dynamics status post caustic ingestion in a pediatric patient: A multidisciplinary case report

A case report of a 10 year old male illustrates the effect of damage to the tongue base, hypopharynx, cricopharyngeus, and esophagus on the sensory and motor components of the swallowing mechanism. The characteristics of the dysphagia were manifested clinically, radiographically, and endoscopically. A myectomy was required to restore functional swallowing as scar tissue formation in the cricopharyngeus severely interfered with the dynamic components of swallowing. A collaborative approach facilitated communication and effective treatment planning; the multidisciplinary components in the management of this case are discussed.

Case Report

Accidental caustic ingestion occurs mainly in the 2- to 3-year-old age group. Up to 33% of patients develop long-term complications that principally involve the gastroesophageal tract, whereas their occurrence at the level of pharyngeal and laryngeal structures is less frequent. When present, strictures are the main disorders that can be observed. In this pathological situation, surgery is the treatment of choice, and several procedures have been described. We report the history of a 3-year-old boy affected by pharyngolaryngeal stenosis due to accidental caustic ingestion. After careful diagnosis, the child underwent surgery by transoral CO2laser. The patient had immediate improvement and restarted oral feeding 1 day after the surgical procedure. An analysis of diagnosis and treatment of this long-term complication is also presented.

Observable Laryngopharyngeal Lesions during the Upper Gastrointestinal Endoscopy

Regardless of outstanding developments in the endoscopic field, laryngopharyngeal lesions are generally considered as a field of otolaryngology, and thus it is thought that not a lot of gastrointestinal endoscopists commonly take interest in these lesions during the upper gastrointestinal endoscopic examinations. Therefore, here in this thesis, I reviewed the availability of upper gastrointestinal endoscopy in laryngopharyngeal area, normal structures of laryngopharynx, and the lesions that can be observed with the standard upper gastrointestinal endoscopic procedure.

Prevention of hypopharyngeal stenosis with silastic sheeting following transoral resection

Hypopharyngeal stenosis following transoral laser microresection (TLM) of hypopharyngeal carcinomas is a rare but devastating complication. Early oral intake and insertion of a nasogastric feeding tube have been thought to prevent stenosis after surgery. However, though rare, severe dysphagia can be caused by hypopharyngeal stenosis following TLM despite preventive efforts. We suggest a new way to prevent hypopharyngeal stenosis by using silastic sheeting with a feeding tube. This stent was inserted in three patients who underwent extensive TLM of hypopharyngeal carcinomas. This technique will help in the treatment and prevention of hypopharyngeal stenosis following TLM in selected patients with wide or circumferential hypopharyngeal tumors.

Endoscopic treatment of upper airway and digestive tract lesions caused by caustic agents

We present our experience in the endoscopic management of upper aerodigestive tract lesions caused by caustic agents. Between 1985 and 2000, 112 patients with upper airway and digestive tract lesions due to caustic agents were treated at the Airways Endoscopic Surgery Unit of Padua Hospital: 44 were male and 68 were female, and the median age was 42.6 years. A retrospective statistical analysis of our case series was made to evaluate the factors that most influenced the severity of injuries and the outcome of treatment. All of the patients underwent videoendoscopic assessment. In 79 cases, the patients came under our observation in the acute phase, whereas 33 presented a picture of chronic lesions. Acute lesions were classified into 3 grades. All acute grade 1 lesions healed spontaneously. In the 32 patients with grade 2 lesions, endoscopic treatment based on removal of necrotic tissue, dilations, and cleansing of abnormal fibrin adhesions resolved the disease in 30 cases (94%). Nine patients (43%) with acute grade 3 lesions developed severe chronic lesions that required subsequent treatments. Rigid endoscopy with diode laser-assisted radial lysis was performed in 32 patients with chronic cicatricial lesions and was successful in 30 cases (94%). We reiterate the need for a standardized multidisciplinary protocol for treating lesions caused by caustic agents and emphasize the essential role of airway and digestive canal videoendoscopy in the diagnosis and treatment of both the acute lesions and chronic cicatricial sequelae.

Caustic soda ingestion -- a case presentation and review of the literature

We present a case report of a 2-year-old child with a hypopharyngeal stricture secondary to caustic soda ingestion. We discuss the initial and long-term management of caustic soda ingestion. In this case the hypopharynx was successfully reconstructed using a pedicled pectoralis major flap. We demonstrate the versatility of this flap, which is traditionally known for its use in adult head and neck surgery.