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The authors take into consideration 21 cases of caustic burns of the superior digestive tract. In 6 cases (29%) the extent of lesions has impelled emergency surgery. In case of total exeresis of the esophagogastric tract, according to their experience, the preferred operation is at closed thorax following the esophageal stripping technique.
Ingestion of caustic agents causes more than 5000 injuries yearly. There is little that the physician can do acutely to attenuate the severity of the internal injuries, but the physician must intensively monitor the patient and react quickly to treat laryngeal burns or transmural penetration of esophageal or gastric burns. Esophageal strictures may appear at any time after the second week. No therapy has been shown to reduce the incidence of strictures. A policy of vigilant anticipation and early dilatation of developing strictures is recommended.
In children, 23 caustic injuries of oesophagus with deep lesions (second or third degree of burn) were treated in pediatric ENT department (Pr ANDRIEU--Rouen) during a 19 years long period. Endoscopy in emergency, nasogastric tube for stent and repeated dilatations were the bases of the treatment. 14 second degree burns and 7 third degree burns were complicated of 9 stenosis and one death. The mean duration of total treatment was 43 months. The mean number of dilatations was 38 months. 4 stenosis were definitely cured. 8 children had normal feeding. Mean following was 8 years with good long term results.
The use of steroid and antibiotic prophylaxis no longer is tenable on the basis of recent studies showing their inability to favorably influence the outcome of caustic injuries. The need for early endoscopic and radiologic assessment if not gastroesophagectomy for severe injuries now is the management of choice. Further efforts to identify high-risk populations and efforts to educate them of the dangers must continue.
The authors report the results of 26 oesophagoplasties carried out using the descending colon for oesophageal stenosis as a result of a caustic lesion. Superior: in 5 cases the anastomosis being made to the pharynx. Inferior: 8 associated gastric lesions being treated either by resection or by short circuit. The remaining oesophagus was removed in two cases. There were two postoperative deaths. In all the remaining patients a satisfactory functional result was obtained.
On the basis of 12 cases of caustic burns of the oesophagus, the authors describe the technique of alimentation, once the acute phase of the first eight days has passed. From the 8th to the 15th days, calories and provided parenterally. An upper GI series is carried out on the 15th day: if the stomach is healthy, the authors fashion an alimentation gastrostomy, if the stomach is damaged, they carry out gastrectomy with alimentation gastrostomy or jejunostomy. In all cases, continuity is re-established by coloplasty two months later.
On the basis of a study involving 21 children treated over a 10 year period, the authors describe a method for the management of a child following the ingestion of a caustic fluid: emergency oesophagoscopy to determine the extent and nature on the lesions, in severe forms, alimentation gastrostomy, which would seem to be preferable to parenteral alimentation, is carried out, on the 21st day, a new endoscopic and radiological assessment, permitting distinction between those cases which are cured and those progressing to stenosis. In this latter group, the choice is made between dilatations and oesophagoplasty on the basis on the lesions present and the development of complications during dilatation.
Accidental ingestion of caustic in childhood is not frequent but severe. It result in oesophagal burns progressing to stricture formation. 18 children with severe oesophagal burns were admitted during the six past years in the Intensive Care Unit of "Hôpital des Enfants-Malades" in Paris. The authors report mainly two cases. They recommend oesophagoscopy and they propose a protocol of treating applied since 1974 in France and foreing countries. The present problem consists mainly in a preventive program to avoid kind of accidents and their sequels in children and their families and finally in the community.
Caustic ingestion is a serious medical problem affecting anywhere from 5,000 to 15,000 persons per year. The factors influencing the type and seriousness of the burn are numerous. Correct diagnosis using endoscopic technique is imperative in choosing the proper treatment whether it be medical or surgical. Stricture is the most common complication with rates from 2% to 4%.
A study of 108 patients who had ingested variable quantities of a caustic substance, most often for suicidal reasons. Hydrochloric acid was the substance most often encountered After stabilisation of any hemodynamic and respiratory disorders, all patients received emergency endoscopy. Subsequent therapy was based on the following endoscopic findings: --Patients, in whom the mucosa was normal, were not hospitalised. --The digestive tract of patients with stage I disorders was rested for 10 days. --Patients with stage III, disorders were operated on as an emergency especially when signs of gravity were present. --Patients with stage II disorders constituted the group which posed most problems in our study. These patients required enteral feeding as soon as possible, via a simple jejunostomy.
The authors report a series of 128 cases of esophageal burns due to caustic soda, treated between 1974 and 1987 in the Dept. of Surgery of the Friguia Kimbo Alumina Factory Hospital. 95% of patients were children aged less than 15. Ingestion was generally accidental. In view of the delay before patients were seen, in addition to parenteral alimentation, nutrition was covered by an alimentation gastrostomy performed in 96% of patients immediately following admission. Dilator treatment was used in 37 patients with 29 good result, 6 failures, and 2 perforations with 1 death. Retrosternal esophagoplasty using the transverse colon was performed in 95 cases with a 96.8% cure rate over a total follow-up period of 1 to 10 years, and 3 deaths. Overall mortality taking all categories together was 5.4%. The authors used these results as a basis for reviewing this condition, attempting to define as a basis for reviewing this condition, attempting to define the therapeutic methods successively used in the Guinea medico-social context.
The diagnostic and therapeutic approach to the maiagement of lesions caused by ingestion of caustic substances has made substantial progress in the past few years and has now been codified. The linch-pins of the present approach are emergency endoscopy for an immediate assessment of the lesions and total parenteral nutrition to reduce the morbidity in patients whose lesions may be expected to take a long time to heal or may require surgical repair. The diagnostic and therapeutic protocol advocated derives from a close examination of the literature and from personal experience.
Cement is a widely used mixture in construction. A corrosive alkali, calcium hydroxide, is liberated as water is added to the lime present in the cement mixture. Skin contact for prolonged periods produces deep chemical burns with thick eschar formation. Five cases of chemical burns to the lower extremities following contact with the cement mixture are presented. When full-thickness burns were present, long periods of hospitalization were necessary for eschar separation prior to skin grafting. Early excision of full-thickness caustic burns with immediate skin grafting diminished the length of hospitalization and returned the patient to work sooner.
68 patients who might have had a caustic oesophageal burn were observed in the E.N.T. department of Enfants Malades Hospital between 1973 and 1977. We describe the causes, the age, the character of the burns analysed after systematic oesophagoscopy, and treatment. The results are studied taking into account the depth of the burn, the nature of the toxic agent and the therapeutic possibilities.
The authors treated is an emergency, severe esofagogastric lesions, in adults, by caustics ingestions. They present seven cases and discuss six deaths. Critical analysis of these observations compared with the findings of pathology and in the literature, permit one to consider the therapeutic indications. The early surgical treatment is suggested as the best way to obtain a more acceptable survival.
The Authors report their experience (16 cases) in esophago-colon plastic surgery for esophageal stenosis from caustics and emphasize the advantages presented by the colon as a substitute for the esophagus, as compared with the stomach and jejunum. Although the results were equally satisfactory irrespective of the selected segment of colon, the Authors indicate their present preference for the left colon because of some technical aspects making the operation easier and more reliable.
Since 1969, in a study of 100 patients hospitalized for severe caustic ingestion meeding intensive surgery, the authors have found 9 cases of critical tracheo-bronchic burns characterized by necrotic lesions. Those lesions constitute a severe complication (6 deaths amongst 9 patients) thus the obsolute necessity of precocius and repeated tracheobronchic fiber endoscopies. In case of an ulcerating or pre-splitting aspect appearing in localised necrotic lesions, the authors preconise in emergency a tracheobronchic plasty using a lung patch. Other treatments are discussed.
The Authors report on their experience regarding lesions of the oesophago-gastric tract due to ingestion of caustic substances. Although prognosis of these patients is always severe, the reported data show that it can be improved by a prompt diagnostic and therapeutic approach. Firstly, a correct evaluation of the lesions through endoscopic examination at a very early stage is capable of guiding the search for the most effective therapy, which, in cases of necrotic, coagulative, haemorrhagic or in any way severe lesions, must always be surgical, begun as early as possible and accompanied by broad spectrum antibiotic cover and, above all, total parenteral feeding.