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PubMed1997

Esophageal replacement in children who have caustic pharyngoesophageal strictures.

Caustic injury to the upper aerodigestive system with scarring of the pharynx, hypopharynx, and esophagus is a challenging reconstructive problem. The authors report on seven patients who required total esophageal replacement from the pharynx to the stomach. Injury occurred from alkali in six and acid in one. Age at injury ranged from 14 months to 14 years (mean, 4.5 years.) in five boys and two girls. Time from injury to esophageal replacement was 6 months to 10 years (mean, 3.5 years). Two required pharyngeal reconstruction before and one after esophageal replacement. Six patients had an isoperistaltic right or transverse colon interposition. One who had gastric necrosis had an ileo-right colonic substernal interposition with creation of a jejunal reservoir. Results of barium swallows showed intact anastomoses in all patients. There were no leaks. Most had some degree of mild to moderate aspiration, and one who had left vocal cord paralysis had initially massive aspiration. Three patients currently eat regular diets; four eat but still require supplemental tube feeds. The authors conclude that children who have hypopharyngeal scarring and obliterated esophageal inlet can undergo a successful colonic esophageal replacement with high proximal pharyngocolic anastomosis.

Adolescent↗
PubMed1998

Stenting for caustic strictures: esophageal replacement replaced.

METHODS: From 1983 to 1996, 31 children with caustic esophageal strictures were seen at Bambino Gesù Children's Hospital; they were all treated conservatively except for two cases complicated by tracheoesophageal fistula. The remaining 29 patients were divided into three groups depending on the treatment, which was modified over the years. Group A (1983 to 1987) consisted of seven patients treated by periodic dilatations; group B (1988 to 1992) consisted of 10 children treated by 40 days of esophageal stenting plus dexamethasone, 0.5 mg/kg/d plus ranitidine plus no oral feeding for 7 to 10 days; group C (1993 to 1996) consisted of 12 cases treated by 40 days of esophageal stenting plus dexamethasone, 1 mg/kg/d plus omeprazole plus early oral feeding resumption. RESULTS: No differences were observed between the three groups of patients with regard to the mean age and to the ingested substance, whereas a significant difference (P = .007) was observed in the mean length of the stricture between group A and C (3.4+/-1.3 and 5.6+/-1.6 cm, respectively). In all but one of the patients (96.5%) complete healing of the stenosis was achieved by conservative treatment, with definitive relief of dysphagia. One patient in group C did not improve after a repeated stenting procedure and was surgically treated. However, in group A, resolution of the stricture was obtained after an average of 19.9+/-14.8 dilatations in a mean period of 25.3+/-17.2 months. In group B, a mean of 12+/-11.3 dilatations were required in a mean period of treatment of 14.1+/-10.6 months. In patients in group C, a mean of 3.5+/-3.2 dilatations were necessary in a mean of 5.8+/-4.8 months. A statistically significant difference was observed both with regard to the number of dilatations and to the duration of treatment, between group A and group C (P = .002) and group B and C (P = .03). CONCLUSION: Esophageal replacement should be considered only in cases complicated by tracheoesophageal fistula or in the rare patients who do not respond to repeated esophageal stenting.

Anti-Bacterial Agents↗
PubMed1985

Caustic substance injuries.

Caustic and corrosive substance ingestions are a significant cause of early and late morbidity and may cause esophageal carcinoma after a long latent period. Initial management should be directed at the assurance of adequate ventilation and cardiovascular stability as well as the prevention of vomiting. Early esophagoscopy (to the level of first lesion, if present) is useful to identify those patients who do not need hospitalization or treatment. Esophagoscopy and contrast esophagram are useful to define the full extent of esophageal injury, but should be withheld until after the acute phase. Glucocorticoids are probably useful in limiting the extent and severity of esophageal stricture, the most frequent and significant long-term sequela. Colon interposition is used in those situations in which dilation of a stricture has been unsuccessful, and may prevent the subsequent development of esophageal carcinoma.

Child, Preschool↗
PubMed1983

[Voluntary poisoning by intravenous injection of caustic soda].

A voluntary intoxication by injection in the left basilic vein of 10 ml of concentrated caustic soda is reported. The main effects were, besides local necrosis, haemolysis, acute renal failure with initial anuresis, intravascular coagulation and cyanosis with a normal Pao2 due to methaemalbuminaemia. This was confirmed by using the usual spectrophotometric methods as well as electrophoretic methods.

Acute Kidney Injury↗
PubMed1978

Perforation of the oesophagus with an oblique--viewing endoscope in a patient with caustic stenosis.

A case of accidental oesophageal perforation during endoscopy in an elderly woman with acute alimentary obstruction of a caustic stenosis is presented. This demonstrates the risks in routine use of oblique-viewing endoscopes, especially in oesophageal exploration. The lesion was successfully treated by internal splinting with a Celestin tube. The indications for this kind of treatment arise in elderly patients with poor general condition in whom a preexisting stenosis guarantees the tight fitting of the tube.

Aged↗
PubMed1997

A case of brain abscess as complication of esophageal dilation for caustic stenosis.

The authors report a case of a two-year-old child with esophageal stricture -- caused first by caustic ingestion and by the end-to-end anastomosis, performed after the excision of the stenotic esophageal segment-- that required repeated dilations. These manouvres unfortunately led to bacteremia and a serious complication of a brain abscess, in the right fronto-parietal area, that was promptly removed. A few months later the child was subjected to an esophageal substitution with a colonic transposition. At present he is in good condition and the follow-up showed normal function of the neo-esophagus.

Anastomosis, Surgical↗
PubMed1998

A critique of systemic steroids in the management of caustic esophageal burns in children.

Five hundred and nineteen NaOH ingestion cases were admitted to our department between 1975 and 1994, and examined via esophagoscopy in the first 48 hours. Two hundred and forty-six patients in this series were diagnosed as severe burns endoscopically. This group of 246 patients were evaluated in a retrospective study to determine whether systemic steroid treatment had any place in preventing stricture formation following severe esophageal burns. Seventy-nine patients in this group were divided into three subgroups and they received methyl prednisolone parenterally in three different regimens. The control group consisted of 167 patients admitted between the years 1986 and 1994 who did not receive any form of steroid treatment. There were no statistically significant differences between the healing rates of the subgroups and the control group (p > 0.01). The authors concluded that systemic steroid treatment has no beneficial effect on esophageal wound healing following caustic esophageal burns.

Burns, Chemical↗
PubMed1997

Waves of excitation on nonuniform membrane rings, caustics, and reverse involutes.

Chemical wave experiments on concentric nonuniform membrane rings are presented together with their theoretical description. A new technique is applied to create a slow inner and a fast outer zone in an annular membrane. An abrupt qualitative change of the wave profile was observed while decreasing the wave velocity in the inner zone. This phenomenon and all the experimental wave profiles can be adequately described by assuming that waves are involutes of a relevant caustic. A possible connection with recent models of atrial flutter is also set forth. (c) 1997 American Institute of Physics.

Journal Article↗
PubMed2003

Use of containment pans and lids for autoclaving caustic solutions.

As a means of decontaminating instruments possibly exposed to Creutzfeldt-Jakob disease, the World Health Organization has recommended immersion and autoclaving in sodium hydroxide. However, this recommendation has raised concerns of possible damage to autoclaves, and hazards to operators as a result of the caustic vapors. A series of experiments has been conducted that demonstrate that there are containment pan-and-lid combinations in which instruments can be autoclaved in sodium hydroxide without risk to the autoclave or the operator.

Creutzfeldt-Jakob Syndrome↗
PubMed1999

Free jejunal patch to reconstruct oral scar contracture following caustic ingestion.

Reconstruction of oral scar contracture is often a challenging problem due to the complex structures and functions of the oral cavity. This report describes the treatment of a patient who sustained extensive oral scar contracture following caustic liquid soda ingestion. Surgical release of the scar contracture formed an S-shaped, thin, long defect that was difficult to cover with a conventional flap or skin graft. A jejunal segment was transferred microsurgically as a patch to reconstruct the defect. It sustained a sufficient oral space to provide full opening of the mouth and good movement of the tongue. A free jejunal flap, used occasionally for reconstruction following oral cancer resection, has significant advantages for restoration of function after release of an oral scar contracture.

Burns, Chemical↗
PubMed1988

Management of severe caustic stenosis of the hypopharynx and esophagus by ileocolic transposition via suprahyoid or transepiglottic approach. Analysis of 18 cases.

Eighteen cases of severe chronic caustic stenosis of the hypopharynx and esophagus are presented. Restoration of digestive continuity was accomplished by retrosternal ileocolic transposition. The cervical approach and the position of anastomosis depended on the status of the hypopharynx. When one pyriform sinus remained open (type I, N = 4), an anterior suprahyoid approach was used in conjunction with lateral hypopharyngotomy because it facilitated the anastomosis and additional minor surgical procedures. When the hypopharynx was completely stenosed (type II, N = 14), a transepiglottic approach consisting of partial horizontal laryngectomy was used because it allowed excision of the supraglottic stricture, restoration of the oropharyngeal cavity, anastomosis to the posterior oropharyngeal wall, management of an eventual laryngotracheal stenosis, and elevation of the laryngeal inlet above the digestive anastomosis. After operation, several endoscopic examinations were required, sometimes combined with reoperation. Return of deglutition assuring normal nutrition was obtained in 61% of patients: 3 of 4 type I and in 8 of 14 type II.

Adult↗
PubMed1980

Motor function abnormalities in acute caustic esophagitis.

Severe motor abnormalities in the human esophagus injured by acid correlated with the degree of mucosal esophageal damage observed by esophagoscopy. In mild caustic esophagitis, motor function remained normal. In severe esophagitis, motor alterations included decrease or absence of high resting pressure in the lower esophageal sphincter with normal swallowing response. In the body of the esophagus, manometric findings were variable and consisted of high resting esophageal pressure, absence of motor response after swallowing, nonperistaltic contraction, and delayed swallowing response. At follow-up motility studies 1 month after injury, esophageal motor function had returned to normal. We suggest that these abnormalities, which could be related to edema or a transient damage of mucosal sensory nerves, contributed to dysphagia.

Acute Disease↗
PubMed1990

Caustic ingestion and esophageal function.

The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow-up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long-term functional evaluation of caustic esophagitis.

Accidents, Home↗
PubMed1996

Speech and swallowing rehabilitation following devastating caustic ingestion: techniques and indicators for success.

Caustic material ingestion, either accidental or intentional, may result in tissue and organ destruction leading to a wide range of complications, including loss of speech and the ability to eat. The esophagus can be reconstructed successfully, but reopening the larynx and upper airway poses a significant therapeutic dilemma. External reconstruction may put the neoesophagus at risk. Loss of the normal swallowing mechanism and the protective supraglottic structures often results in fatal aspiration. The authors present three cases of successful endoscopic laser recannulation of the larynx with esophageal replacement. The discussion includes surgical technique and the tools used to determine the success of the reconstruction, including computed tomographic scanning, modified barium swallow, placement of an upper esophageal anastomosis, psychologic support, and speech and swallowing therapy.

Adult↗
PubMed1979

Caustic burns of the esophagus: ten-year results of aggressive care.

In 1967, care of esophageal burns from caustic substances was altered to include immediate esophagoscopy, high doses of steroid, and follow-up dilatations plus cine-esophagograms as needed. Previously, this area averaged six repairs of esophageal stricutre each year. Since 1967, there have been no esophageal strictures in 100 patients.

Burns, Chemical↗
PubMed2005

Detection of tracheoesophageal fistula caused by ingestion of a caustic substance by esophageal scintigraphy.

A 4-year-old boy was referred for scintigraphic evaluation of esophageal transit 24 hours after he had ingested sodium hydroxide. After oral administration of Tc-99m sulfur colloid, scintigraphy showed marked and prolonged retention of the radioactive bolus in the middle and lower thirds of the esophagus. Three weeks after ingestion of the caustic substance, repeat scintigraphy was requested to evaluate esophageal transit and gastric-emptying. In this presentation, a tracheoesophageal fistula was a consequence of sodium hydroxide ingestion and was identified with radionuclide scintigraphy before there was clinical and radiologic detection.

Administration, Oral↗
PubMed2002

Improved semiclassical density matrix: taming caustics.

We present a simple method to deal with caustics in the semiclassical approximation to the thermal density matrix of a particle moving on the line. For simplicity, only its diagonal elements are considered. The only ingredient we require is the knowledge of the extrema of the Euclidean action. The procedure makes use of complex trajectories, and is applied to the quartic double-well potential.

Journal Article↗