Esophageal Injury: A Study of Caustic Ingestion in 83 Children

Ibrahim Daradka

Abstract


Objectives: To determine the incidence, management and outcome of esophageal strictures caused by caustic ingestion in children.
Methods: A retrospective review of 83 patients treated for caustic esophageal ingestion during 1985-2004 at King Hussein Medical Center (KHMC). Data were collected: age at presentation, sex, causative agent, incidence of esophageal strictures, complication and outcome were analyzed.
Results: The accidental ingestion of corrosive agents is a major cause of esophageal strictures in children. 83 patients sustained caustic substance ingestion (53 boys and 30 girls).Age at presentation varied from 3 months to 13.5 years, with a male: female ratio of 1.7:1 .The majority of caustic substances ingestion was household cleaners (detergents & bleaches) in 41, drain openers (cleaners) in 19. All patients were examined via esophagoscopy in the first 24-72 hours, then by another endoscopy 4 weeks later for follow-up, but in 5 delay patients. The incidence of esophageal stricture was observed in 22.8% (19/83) of the children. The treatment was based on periodic dilatations anterograde (rod) or thread-guided bougies with gastrostomy. Pneumatic balloons have also been employed. Dilations therapy alone was successful in 73.6% (14/19) of patients for 7-36 months duration. There was no mortality and only three esophageal perforations, which did not require surgical treatment.
Conclusion: Caustic esophageal strictures in children can be treated by conservative measure if sufficiently long- term dilatation performed .Esophageal replacement should be considered only in complicated cases or in the rare patients who do not respond to repeated esophageal dilatations.

Keywords


Caustic ingestion, Esophageal strictures, Endoscopic dilatation

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