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PubMed1983

Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children.

The accuracy of signs and symptoms as predictors of the presence and severity of esophageal injury was evaluated in 378 children admitted to three pediatric hospitals between 1970 and 1980. The signs and symptoms analyzed included nausea, vomiting, dysphagia, refusal to drink, abdominal pain, increased salivation, oropharyngeal burns, and abdominal tenderness. The severity of lesions found at esophagoscopy in 378 children was graded from grade 0, no lesion, to grade 3, perforation. Of the 298 patients demonstrating signs or symptoms, 243 (82%) had a grade 0 or 1 lesion, 55 (18%) had a grade 2 lesion, none had a grade 3 lesion, and five (2%) developed a stricture of the esophagus. Among the 80 patients without signs or symptoms, 70 (88%) had a grade 0 or 1 lesion, ten (12%) had a grade 2 lesion, none had a grade 3 lesion, and one (1%) developed a stricture of the esophagus. When individual signs or symptoms were correlated with the severity of esophageal lesion, vomiting (33%) followed by dysphagia (25%), excessive salivation (24%), and abdominal pain (24%) were most frequently associated with a grade 2 or 3 esophageal lesion. A similar percentage of a grade 0 or 1 (82% v 85%), a grade 2 (18% v 15%), and a grade 3 (0%) esophageal lesion followed the ingestion, respectively, of an alkali (324 patients) or an acid (54 patients). In six patients (2%) stricture occurred only following an alkali ingestion. These data demonstrate that signs and/or symptoms do not adequately predict the presence or severity of an esophageal lesion following the ingestion of a caustic substance.

Abdomen↗
PubMed1994

[Diagnosis and treatment of caustic ingestion].

The acute diagnostic procedures in caustic ingestion are primarily directed towards the recognition of life-threatening complications such as airway obstruction, perforation of inner organs and, in severe acid ingestion, metabolic acidosis. The endoscopic injury grading forms the basis of a differentiated treatment. Not all patients need endoscopic evaluation; the indications are discussed. The treatment is controversial. Fluid given orally is recommended within few minutes of ingestion, and thus rarely administered at the arrival to the hospital. Here, the task is to secure the vital functions and to relieve pain. The prevention of oesophageal stricture in deep, (near)-circumferential ulcerations is essential for the further treatment. Once-formed strictures are usually treated with dilatation.

Burns, Chemical↗
PubMed1994

Foreign bodies, bezoars, and caustic ingestion.

Children, particularly infants, frequently put objects into their mouths, and occasionally these objects are swallowed. Fortunately, most foreign bodies are harmless and will pass spontaneously through the gastrointestinal tract. Some foreign bodies such as the rare bezoar or caustic substances, provide unique clinical challenges. This article provides guidelines for the management of such problems.

Bezoars↗
PubMedDate not supplied

[Caustic rectal stenosis. Trans-anal resection using an EEA stapler].

An original treatment of caustic rectal stenosis due to abuse of analgesic suppositories is presented. The stenosis had been excluded by distal colostomy during 2 years before reconstruction of the circuit was attempted. Anatomically, the stenosis appeared as a complete diaphragm which could be recanalized by an EEA stapler for circular anastomosis, installed in two sites: endoluminal from the colostomy and perineal. After a 2-year follow-up, the anatomical and functional results are satisfactory.

Aged↗
PubMed1993

Caustic ingestion and esophageal injury.

This article reviews esophageal anatomy and the physiology of swallowing. A discussion of the epidemiology, pathology, evaluation, and management of patients with esophageal injury secondary to caustic ingestion is presented.

Adolescent↗
PubMed1995

[Treatment of caustic stenoses of the upper digestive tract].

Stenosis of the upper digestive tract developed in 22 patients with stage IIB or stage III caustic burns due to massive ingestion of an alkaline substance in 18 cases and an acid substance in 4 cases is analysed. Emergency oesogastrectomy without thoracotomy was performed in emergency situations in 10 patients in whom mortality reached 30%. For the remaining 12 patients with minimal stage IIB lesions, a jejunostomy was opened for enteral nutrition. After three months, stenosis developed in 10 cases and required surgical treatment in 7 after failure of endoscopic dilatations. Surgery included retrosternal coloplasy with oesophagectomy for 3 patients. There were no deaths. Two patients with a stenosis of the cervical anastomosis were treated endoscopically. These results suggest that the use of the endoscope in the acute phase can help ascertain the best management technique and confirms that stage IIB stenosis can develop a tight stenosis in 50% of the cases. This situation requires surgical treatment in 70% of the cases.

Adult↗
PubMedDate not supplied

[Severe gastroesophageal lesions due to caustics: the role of nutritional support].

AIM: Describe the clinical-nutritional state of patients with severe digestive lesions after the ingestion of caustic substances, as well as their nutritional support (NS). PATIENTS AND METHODS: We studied 5 patients diagnosed by means of early endoscopy, treated with artificial nutrition, 4 of whom used enteral nutrition. During the acute phase of the disease, an evaluation of the nutritional state (ENS) was done, by means of the following parameters: body mass index (BMI), creatinine/height index (CHI), visceral proteins, nitrogen content of 24 h urine, and plasma zinc level. The corrected Harris-Benedict equation was used to calculate the energy needs. RESULTS: The BMI did not experience significant changes. The CHI decreased in a large degree. The long life visceral protein did not change notably, and those of intermediate and short life increased. The losses of nitrogen were increased. We found hypozincemia in 4 of the cases. The mean Kcal provided was 2323 +/- 105. CONCLUSIONS: In the described patients, given their catabolic condition, and early ENS and NS should be done. If at all possible, the NS shall be enteral, with or without parenteral support. In our study we have found a cessation of the weight loss, a decrease of somatic protein with a short term re-filling of the visceral protein pol. The zinc levels should be monitored.

Aged↗
PubMed1996

[Management of caustic esophagitis in adults].

The experience of surgical management of caustic ingestion in adults started a quarter of a century ago in the Paris Poisons Centre. It was found that, inasmuch as certain cases of massive ingestion require major emergency surgery, the patient must be received by a competent surgical unit, associated with an Intensive Care Unit with permanent availability of gastrointestinal and tracheobronchial fibroscopy. The assistance of an ENT surgeon can be precious, and a psychiatrist is often necessary. The Saint Louis Hospital visceral surgery unit in Paris has developed a specialized on-call system. Its current experience concerns approximately one thousand patients. Comparison with other French or European experiences at the time of preparation of this report, presented to the 97th French Surgery Congress in 1990, allows the definition of a consensual management.

Adult↗
PubMed1984

Blunt thorax oesophageal stripping: an emergency procedure for caustic ingestion.

We report our experience with an original procedure which we have applied to the management of acute necrotic caustic burns of the upper gastro-intestinal tract. Blunt thorax oesophageal stripping is performed through a cervicotomy and a laparotomy, thus avoiding a wide pleural exposure and the frequent and often fatal respiratory complications of a thoracotomy. The stripping method permitted survival of 13 of 17 patients and is thus considered to be a safer and more successful technique than open thoracic oesophagectomy.

Adult↗
PubMed2000

The Influence of Alkali Metal Ions on Homogeneous Nucleation of Al(OH)(3) Crystals from Supersaturated Caustic Aluminate Solutions.

Homogeneous nucleation of Al(OH)(3) crystals from synthetic, optically clear, caustic aluminate solutions and the influence of alkali metal ion (Na(+) versus K(+)) have been investigated under isothermal, batch crystallization conditions. The nucleation kinetics showed a seventh-order dependence upon Al(III) relative supersaturation and a strong temperature effect. Activation energy of 160 kJ mol(-1) and interfacial energy of 33 mJ m(-2) were estimated and found to be independent of alkali ion, as was the Al(OH)(3) equilibrium solubility. The nucleation rate, however, was faster in aging sodium than in potassium aluminate solutions. It appears that Na(+) ions provide greater stability for the formation and densification of Al(III)-containing, supramolecular clusters which grow more rapidly into Al(OH)(3) crystallites than do K(+) ions. The development of the Al-OH octahedral structure of Al(OH)(3) nuclei is an alkali metal ion-mediated, chemical reaction-controlled condensation process, displaying specific gibbsite (gamma-Al(OH)(3))-bayerite (alpha-Al(OH)(3)) dimorphism. Furthermore, significant differences in the level of alkali ion incorporation, reflecting in the purity and morphology of the crystalline product, were observed. Copyright 2000 Academic Press.

Journal Article↗
PubMed1977

Detergent enema: a cause of caustic colitis.

A 5-year-old boy developed acute colitis followed by stricture formation as a result of a detergent enema. The acute phase of the caustic induced colitis was reproduced in the dog and the rat using full strength and diluted detergent enemas. The severity of the experimental colitis was shown to be directly related to the concentration of the detergent.

Animals↗
PubMedDate not supplied

Retrograde esophageal balloon dilatation: salvage treatment of caustic-induced stricture.

A 14-month-old boy with severe esophageal strictures following ingestion of potassium hydroxide is described. Initially, treatment was by surgical bougienage but following esophageal perforation, 65 balloon dilatations were performed over an 8-month period using a retrograde approach via a feeding gastrostomy without anesthesia or sedation. A further nine dilatations in the following 6 months were performed using a per-oral approach after establishment of full oral nutrition and removal of the gastrostomy. The main advantage of the retrograde approach was the large number of dilatations that could be performed without anesthesia in an infant. This has allowed nonoperative treatment of a high grade caustic esophageal stricture which would otherwise have required esophageal replacement.

Burns, Chemical↗
PubMed2000

Colon interposition in a patient with total postcricoid stenosis after caustic ingestion and preservation of full laryngeal function.

Caustic burns of the upper aerodigestive tract continue to be a significant clinical problem. However, the available literature uncommonly mentions changes affecting the larynx. We could find only one publication in which four cases of high hypopharyngeal stenosis were described in detail and where the functional outcome of the laryngeal function was stated as partially saved. We describe here a case of total retrocricoid stenosis in a 28-year-old woman that was caused by lye ingestion. A life-saving gastroesophagectomy was performed by the Department of General Surgery. Reconstruction of the esophagus was carried out with mobilized right colon, which was meticulously sutured circumferentially behind the arytenoids and on the prevertebral fascia. The anatomy of the larynx and its nerve supply were scrupulously maintained intact. We believe that our patient's rehabilitation was due mainly to an intensive 18-month program of care, following which all laryngeal functions recovered with normal voice and swallowing patterns.

Adult↗
PubMed1992

Transhiatal esophagectomy and colonic interposition for caustic esophageal stricture.

From January 1986 through 1990, 70 children (42 boys, 28 girls) with esophageal stricture resulting from ingestion of caustic potash underwent simultaneous esophagectomy and colonic interposition utilizing the transhiatal esophageal approach. At the time of the procedure, their ages ranged from 14 months to 6 years (mean, 3.2 years). Thoracotomy was needed in one patient due to accidental injury to the tracheal during esophageal mobilization. There were 3 deaths from respiratory failure. Otherwise, morbidity was low, and there were satisfactory long-term functional results. The use of isoperistaltic left colon based on both ascending and descending branches of the left colic vessels resulted in survival of all grafts. End-to-side esophagocolic anastomosis decreased the incidence of both postoperative leak (2 instances) and late stenosis (1 case needed surgical revision). Construction of a length of colonic graft equal to the gap between the esophagus above the stricture and the stomach and fixation of the graft to the edge of the esophageal hiatus reduced the incidence of late colonic redundancy in the chest; this did occur in 4 cases but was not associated with dysphagia. Routine pyloroplasty and anterior cologastric anastomosis to the gastric antrum contributed to the absence of gastrocolic reflux and peptic ulceration in this series.

Anastomosis, Surgical↗
PubMed1995

Management of tracheoesophageal fistula as a complication of esophageal dilatations in caustic esophageal burns.

The authors report on eight patients with caustic esophageal burns in whom tracheoesophageal fistula (TEF) developed during dilatation programs. This study covered a period of 17 years between 1975 and 1992. The age of the patients ranged from 1.5 to 8 years (mean age, 3.4 years). TEF developed after 5 to 43 months after injury (mean, 20.05 months). In each case, after documentation of the fistula by esophagography, esophagoscopy, and/or bronchoscopy, the fistula was blocked by an intraluminal esophageal stent, a polytetrafluoroethylene (PTFE) tube with a large lumen (10-mm diameter maximum). In this period, patients were fed via a jejunostomy tube and by total parenteral nutrition (TPN) if indicated, while the existing pneumonia was being treated. In one patient, fistula closed spontaneously during the stent application program, which ended with a patent esophagus. In two patients primary closure of TEF was attempted. In one of them fistula recurred and in the other it was technically impossible to separate the esophagus from trachea safely because of the very tight adhesions. In five patients a two-stage coloesophagoplasty was performed to bypass the fistulated esophagus. In the first stage, retrosternal pull-through of the colon and coloesophagogastric anastomosis was performed. In the second stage, closure of the distal esophagus and cervical coloesophagostomy was carried out. The patient with the primary closure attempt and one patient with stage 1 coloesophagoplasty died 3 and 4 months, respectively, after the operations. The cause of death was uncontrollable pneumonia in both cases. Follow-up of the four patients showed no complications. Another fistula patient is currently on stent treatment program with pneumonia under control.(ABSTRACT TRUNCATED AT 250 WORDS)

Burns, Chemical↗
PubMed1989

Treatment of severe microstomia caused by swallowing of caustic soda.

Treatment of severe microstomia caused by swallowing of caustic soda is presented. The oral cavity was severely constricted because of mucosal adhesions. We used a free forearm flap for reconstruction of the oral cavity and vermilion flaps at the oral commissure, with satisfactory results. A technique is presented, and the problems with respect to the reconstruction of the oral cavity are discussed.

Adult↗
PubMed1989

Treatment of caustic ingestion.

This article reviews the management of patients following caustic ingestion. The initial care is conservative, consisting mainly of IV antibiotics and steroids. Patency of the airway is of immediate concern and achieved via either intubation or tracheostomy. Early intervention with oral splint therapy is recommended to minimize scar contracture. It is important that the oral and maxillofacial surgeon be acquainted with the primary care of such patients, as well as with the subsequent management of the secondary complications of decreased stomal opening, loss of the mucobuccal fold, and limitation of tongue movement.

Alkalies↗
PubMed2005

The use of a sequential leaching procedure for heavy metal fractionation in green liquor dregs from a causticizing process at a pulp mill.

A five-stage sequential leaching procedure was used to fractionate heavy metals (Cd, Cu, Pb, Cr, Zn, Fe, Mn, Ni, Co, As, V, Ba and Ti) in green liquor dregs into the following fractions: (1) water-soluble fraction (H2O), (2) exchangeable fraction (CH3COOH), (3) easily reduced fraction (HONH3Cl), (4) oxidizable fraction (H2O2 + CH3COONH4), and (5) residual fraction (HF + HNO3 + HCl). The green liquor dregs were derived from a causticizing process at a pulp mill at Kemi, Northern Finland. According to the leaching studies, the leachability of heavy metals in the water-soluble fraction varied between 0.5 and 2 mg kg(-1) expressed on a dry weight (d.w.) basis, indicating relatively low bioavailability of the metals. However, the concentration of Mn (2065 mg kg(-1); d.w.) showed a strong and of Zn (17.6 mg kg(-1); d.w.), Ni (39.7 mg kg(-1); d.w.) and Ba (32.0 mg kg(-1); d.w.) slightly tendency to be extracted in the exchangeable fraction. In addition, Zn, Mn, Ni, Co, V and Ba showed clear leachability in the easily reduced fraction, as well as Cd, Cu, Cr, Zn, Mn, As and Ba in the oxidizable fraction. For Cd, Cu, Cr, Zn, Mn, Ni, Co, Ba and Ti, the sum of leachable heavy metal concentrations in fractions 1-5 agreed relatively well with the "total" heavy metal concentrations. Recoveries of the sum of fractions 1-5 were 84-56% of those obtained by the US EPA method 3052 (i.e. concentrations obtained after microwave oven digestion with a mixture of HF and HNO3).

Chemical Fractionation↗