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PubMedDate not supplied

[Caustic lesions of the upper digestive tract. Apropos of 191 cases].

The authors report 191 cases of caustic burns of the upper gastro intestinal tract. HCL is the most incriminated caustic. 6 of them are severe cases: 2 are dead immediately, 4 were operated in emergency and 3 died. The staging based on fibroendoscopy allow us to make a prognosis. 43% of the cases stage III and 14% stage II developed a stenosis. A nasogastric tube is performed at 135 cases. It's used for an enteral artificial feeding and for oesophageal stenting in burns liable to cause stenosis. Through the results of this study and a review of the literature we may establish a therapeutic schema adapted to our conditions.

Accidents↗
PubMed1984

[Prevention of caustic stenoses of the esophagus with an intraesophageal mold].

The various methods for the management of full-thickness caustic burns of the esophagus, whether by early bougienage or by corticosteroïd treatment and/or use of an intraluminal catheter, have proved unsuccessful to this date. The use of an intraluminal splint kept in place during 3 weeks, as advocated by Reyes, slows down the growth of exuberant granulation tissue and prevents the formation of synechia and stricture during the healing process. Reyes's method was modified as follows: after a delay of 4 or 5 days, an esophagoscopy is performed along with a histologic study in order to ascertain the extent of the burn. Then, a Blackmore catheter is introduced in the esophagus to serve as a splint. No corticosteroids are used. The authors report 3 cases of deep caustic burns of the esophagus as attested by endoscopic and histologic studies, which have been successfully treated.

Burns, Chemical↗
PubMedDate not supplied

[Ingestion of caustics in childhood: proposal for a therapeutic protocol].

Caustic ingestion is a traumatic event not rare in the infancy. The authors, after a brief discussion of their cases and after a revision of the literature, propose a therapeutic protocol for the treatment of caustic ingestion in the infancy. This protocol is based on the esophagoscopy in the first day and on the antibiotic and corticotherapy in the first two weeks. When there is an esophageal stenosis, the authors propose weekly esophageal dilatations.

Anti-Bacterial Agents↗
PubMed1982

[Caustic burns of the esophagus in children. Apropos of initial endoscopy and routine sizing].

The advantages and indications for initial endoscopy in esophageal caustic burns in children are discussed in relation to 37 such cases, 13 of which were severe lesions. However, the procedure does not provide initial valid assessment of prognosis in severe 2nd and 3rd degree burns. The definite advantages of early and prolonged esophageal stenting in burns liable to provoke stenosis are emphasized: the esophagus is kept at rest and alimentation by the natural pathways can be maintained. Tubage also avoids gastrostomy or other early surgical procedure in the children, with a subsequent more satisfactory course during dilatations, their frequency thus being diminished. The usual inocuity of sodium hypochlorite after accidental ingestion does not justify endoscopic exploration but esophageal and gastric endoscopic examinations should be performed in all children after ingestion of major caustic agents (soda, acids), whether it is certain or simply suspected that ingestion has occurred, even when clinical signs are absent.

Adolescent↗
PubMed1978

[The radiological appearances of caustic burns in the upper intestinal tract (author's transl)].

Seventy-nine caustic burns of the upper gastrointestinal tract were divided into early and late effects. The radiological findings were analysed and discussed. The central role of radiology proved to be indisputable, particularly for demonstration of a perforation and for the control of treatment. Endoscopy is of particular value in the diagnosis of caustic burns if the radiological findings are negative, for following treatment and for clarifying atypical late changes.

Burns, Chemical↗
PubMed1995

[Application of oesophagogastric double anastomosis in the treatment of esophageal caustic stricture].

Between 1982 and 1992, nine cases of oesophageal caustic stricture underwent oesophagogastric double anastomosis with success. There was no need to dissect and resect the strictured esophagus, and traumatizing organs adjacent to oesophgus was avoided. This method also eliminated the possibility of occurrence mediastinal abscess due to postoperative rebindling or infection by the esophageal segment. Indications for this operation are as follows: the esophageal stenosis located below the aorta arch; the stomach mobilized and pulled up to the upper level above the aorta arch dispite the presence of scattered caustic shrinkage; to assess the location and extent of corrosive injury and determine the level of reestablishment of the digestive tract through routine preoperative fiberoptic oesophagoscopy. This simplified procedure shortens the operating time, but yields excellent result.

Adolescent↗
PubMed1987

Management of caustic ingestion in adults.

The treatment of 484 adults with caustic ingestion injury is discussed. Signs and symptoms are an unreliable guide to injury and a chest X-ray and fibreoptic endoscopy should be performed as soon as possible. All of the 250 patients who developed superficial lesions of the oesophagus, stomach or duodenum experienced healing without sequelae. Forty-four patients required emergency surgery of whom twenty-four died and oesophagectomy without thoracotomy is now advocated for this group, followed by interval surgery to restore continuity. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complication, 3 succumbed to aorto-oesophageal fistula, 12 survived following delayed surgery for complications and 83 developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment.

Adolescent↗
PubMed1995

Oesophagoplasty in the treatment of caustic oesophageal strictures in children.

A total of 111 children with caustic oesophageal strictures who have subsequently undergone oesophagoplasty were reviewed. Overall 80 patients had a retrosternal colon transplant; a two-stage operation with delayed cervical oesophagocolostomy was the preferred method in 68 of them. Of those having retrosternal surgery two had total necrosis and three had necrosis at the distal end of the transplant. The incidence of cervical anastomotic stenosis was six of 12 in the group undergoing single-stage surgery, compared with seven of 68 in those having the two-stage operation. Ten patients underwent a right thoracic retrohilar colon transplant, seven of whom developed redundancy of the graft. Redundancy was a lesser problem in the retrosternal placement of the transplant. Three patients underwent jejuno-oesophagoplasty which resulted in terminal necrosis in one patient and total necrosis in two. The remaining 18 patients had segmental resection of the intrathoracic oesophageal stenosis followed by end-to-end anastomosis. The overall mortality rate in the series was 3.6 per cent (four of 111).

Anastomosis, Surgical↗
PubMed1995

Emergency management of caustic ingestion in adults.

A study of 57 patients admitted to the Department of Emergency Surgery at the Ospedale Maggiore in Milan between 1980 and 1992 following the recent ingestion of a caustic substance is presented herein. Through this study, an aggressive diagnostic and therapeutic approach has been employed, including early surgery which plays a fundamental role in the prevention of acute hemorrhagic or perforative complications as well as in the development of scar tissue and neoplastic strictures over time. The criteria for early emergency surgery were the presence of endoscopic grade 3 and 4 lesions as well as those on the borderline between grades 2 and 3 with clinical symptoms. In 11 patients with lesions of moderate severity, the treatment of choice was medical therapy, which required subsequent surgical intervention for strictures in 5 patients. In 13 patients with severe lesions, an early surgical approach was performed with a mortality rate of 23%.

Adolescent↗
PubMed2002

Benign hepatic portal venous gas following caustic ingestion.

Hepatic portal vein gas has been documented in numerous conditions and is traditionally regarded as a poor prognostic sign. There are, however, several reports of portal vein gas with a benign course. We report the first case of transient hepatic portal vein gas secondary to the ingestion of a caustic substance. The literature of hepatic portal vein gas in benign disease is reviewed.

Administration, Oral↗
PubMed1999

Conservative treatment of caustic esophageal injuries in children: 20 years of experience.

The authors present their experience in the medical treatment of 1, 296 caustic esophageal injuries in children over the last 20 years in two study groups, one comprising the period up to 1989 and the other 1990 to 1996, comparing the different treatments used in each group. The treatment was based fundamentally on dilatations with anterograde mercury bougies, Savary bougies, or retrograde thread-guided bougies with gastrostomy. Pneumatic balloons or stenting procedures have also been employed in the last 3 years. Early fiberendoscopy was used systematically in the second group, which provides a more accurate evaluation of the esophageal lesions. Antibiotic coverage was done systematically during the first 10 days in all serious cases, while steroids were employed routinely only in the last 3 years. The results were similar in both groups, with a dilatation average of 32 in the first and 30 in the second group and an initial dilatation interval of 3 to 4 weeks in both. Using updated exploration and dilatation techniques, we drastically reduced the number of gastrostomies needed for retrograde thread-guided dilatations from 51 in the first group to 5 in the second, consequently improving the patients' life quality. There was no mortality and only five esophageal perforations, which did not require surgical treatment.

Anti-Bacterial Agents↗
PubMed2006

Methamphetamine exposure presenting as caustic ingestions in children.

With the growing prevalence of methamphetamine use and production in home laboratories, children are at risk for injuries resulting from living in a drug-endangered environment. Although the ingestion of household cleaners is usually accidental and not a result of illicit drug use or production, medical providers must be aware of the chemicals associated with methamphetamine and illicit drug production to identify patients harmed in this environment. We present the first reported cases of children harmed by ingesting caustic substances used in the production of methamphetamine in the home.

Administration, Oral↗
PubMed2006

Pharyngo-colostomy with supraglottic partial laryngectomy in caustic oropharyngeal stricture.

We present two cases of chronic caustic stricture from the oropharynx to the entire esophagus combined with laryngeal stricture in which the piriform sinuses were stenosed. The restoration of digestive continuity was accomplished by end-to-end pharyngo-colostomy at the level of the cricoid cartilage through the posterior mediastinal route. Supraglottic partial laryngectomy and pharyngoplasty were done simultaneously for the laryngeal and oropharyngeal stricture. The patients were able to swallow a soft blend diet to regular diet with negligible penetration.

Adult↗
PubMed2004

Minimally invasive esophagectomy for caustic esophageal stricture in children.

Esophageal stricture after lye ingestion in children is the most frequent indication for esophagectomy in children, but this operation entails significant risks for complications. With continuing advances in minimally invasive technology, complex procedures such as esophagectomy can be performed using small incisions, with the aim of reducing morbidity and mortality. Experience with minimally invasive esophagectomy is limited and has involved thoracoscopic dissection with the addition of laparotomy for gastric mobilization. The authors report a case of intractable caustic esophageal stricture in a child treated by a totally minimally invasive esophagectomy through a combined thoracoscopic and laparoscopic approach. In adult patients, this procedure has been associated with decreased hospital stay and more rapid return to normal activities, and we believe similar benefits will be obtained in children. Until further studies are done to show the advantage over the standard open technique, this procedure should be performed only in centers with experience in open esophageal surgery in children as well as by surgeons with advanced thoracoscopic and laparoscopic skills.

Adolescent↗
PubMed1986

Caustic injuries to the esophagus in children.

The ingestion of caustic chemical agents, usually accidentally by children, produces a wide range of injuries from minor mouth burns to necrosis of the esophagus and stomach. The type of agent, amount, concentration, and duration of exposure are the determining factors. The treatment for the average burn is fairly well standardized, but the serious injuries require prompt recognition of complications and appropriate therapy to prevent more serious complications.

Burns, Chemical↗
PubMed1996

Caustic and thermal epiglottitis in the adult.

The presence of dysphagia, drooling, and stridor in an adult subsequent to thermal or caustic injury should alert the treating physician to the possibility of injury to the supraglottic structures with resultant epiglottitis. These adults possess many of the features seen in acute infectious epiglottitis and should be handled with the same consideration for potential upper airway obstruction. Epiglottic injuries of this type should be suspected in adults with mental disorders or communication difficulties.

Adult↗
PubMed1985

Liquid caustic ingestions: an in vitro study of the effects of buffer, neutralization, and dilution.

Changes in pH and temperature of solutions of common commercial liquid caustics were determined in vitro following the addition of neutralizing agent, buffer, and diluent. Neutralization of strong base was complete following the addition of less than twice the volume of weak acid with only a minimal release of heat. Buffer added to a strong acid caused an immediate temperature elevation without changing the pH; a gradual rise in pH followed. Large volumes of diluent caused little change in temperature or pH of either strong base or strong acid. We conclude that dilution as a first-aid measure is ineffective, whereas buffer is ineffective and possibly harmful. Neutralization is effective in reversing pH change, but in vivo studies are needed to confirm the relative roles of pH extremes and heat in the genesis of tissue injury.

Buffers↗
PubMed2002

Long-term functional results of transhiatal oesophagectomy and colonic interposition for caustic oesophageal stricture.

Aim of the study. Various surgical procedures have been advocated for replacement of the scarred oesophagus in children. We report here on our experience of oesophago-coloplasty. Methods. Over a 10-year period, 100 children (62 boys, 38 girls) with intractable caustic stricture of the oesophagus underwent transhiatal oesophagectomy and left colonic interposition. Their age at the time of reconstruction ranged from 14 months to 8 years (mean 3.4 years). Results. The patients were followed up post reconstruction for a period ranging from 5 to 15 years. There were 3 deaths from respiratory failure. Stricture of the cervical oesophagocolic anastomosis occurred in 6 patients and needed repeated dilatations (in 2 patients) and surgical revision (in 4 patients). Mild redundancy of the colonic substitute in the chest was noted in five cases, but in no case there was dysphagia necessitating revision of the colonic transplant. Peptic ulcer or symptomatic gastric-colic reflux was not seen in this group of patients. All of our patients are able to swallow and eat a normal unrestricted diet, they are gaining weight and enjoying a normal life pattern. Conclusion. We conclude that isoperistaltic left colon, based on both the ascending and descending branches of the left colic vessels with simultaneous oesophagectomy utilising the transhiatal approach, is the best substitute for a scarred oesophagus in children with satisfactory long-term functional results.

Burns, Chemical↗