ESOPHAGEAL PERFORATION AND CAUSTIC INJURY: Emergency management of caustic ingestion

1997 ◽  
Vol 10 (2) ◽  
pp. 95-100 ◽  
Author(s):  
B. Andreoni ◽  
M. L. Farina ◽  
R. Biffi ◽  
C. Crosta
Keyword(s):  
Emergency Management ◽  
Esophageal Perforation ◽  
Caustic Ingestion ◽  
Caustic Injury

scholarly journals A183 UPPER GASTROINTESTINAL CAUSTIC INJURIES: A SINGLE CENTRE CASE SERIES

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 51-53
Author(s):  
M Monachese ◽  
N Griller ◽  
E Yong
Keyword(s):  
Case Series ◽  
Oral Intake ◽  
Gastric Injury ◽  
Poison Control ◽  
Caustic Ingestion ◽  
High Quality ◽  
The Third ◽  
Caustic Injury ◽  
Lethal Event ◽  
Caustic Injuries

Abstract Background Caustic esophageal and gastric injury is a rare, but potentially lethal event. The 2017 American Association of Poison Control reported only 193,000 cases of caustic ingestion (1). Caustic agents are acidic or alkaline. The pH of the ingested substance dictates the type of injury and the area of the gastrointestinal track most at risk. The most common culprit agents are alkaline including, for example, bleaches, drain openers and dishwashing detergents. Due to the rarity and natural history of this disease there are very few high-quality studies for clinicians to refer to when managing these patients. Aims We present three cases of caustic ingestion and provide a review of current best practice standards. Methods Between August and September 2019, three patients were admitted to Sunnybrook Health Sciences Centre at the University of Toronto for caustic injury. All three patients were referred to the gastroenterology service and underwent an esophagogastroduodenoscopy (EGD) to assess the degree of esophageal and gastric injury. Patients were followed both in hospital and in the outpatient setting for ongoing surveillance and repeated endoscopic evaluation. Patient demographics, treatment, endoscopic findings and outcomes were collected. Results Three patients intentionally ingested caustic agents, were admitted to hospital and managed by the gastroenterology service. Patients were a mix of ages, genders and ethnicities. All ingestions were strong alkali agents including sodium hydroxide and sodium hypochlorite. All patients underwent an EGD within 24 hours of presentation and caustic injury was graded using the Zargar classification (2). All patients were started on intravenous proton pump inhibitor therapy. All patients were initially made nothing per mouth and ability to resume feeds was assessed based on symptoms. Patient 1, Zargar grade 1, was able to resume oral intake within 48 hours and progressed to a regular diet without complications. Patient 2, Zargar grade 2a, required 5 days of TPN and bowel rest after which a liquid diet was initiated and advanced without complications. The third patient, had a severe injury (Zargar grade 3b), requiring a prolonged hospital stay. He was on TPN for three weeks before transitioned to tube feeds. Conclusions Caustic mucosal injuries are an infrequent, but potentially lethal event requiring urgent assessment and management by a team including gastroenterologists, thoracic and abdominal surgeons, dieticians and intensivists. High-quality evidence to guide management of caustic injuries remains limited. In our case series, there was a wide spectrum of degree of mucosal injury. All 3 patients were managed in a consistent fashion based on current recommendations. Two of three cases had a rapid recovery with the ability to resume oral intake and return home. The third patient remains in hospital, requiring a high level of supportive care. Funding Agencies None

Emergency management of caustic ingestion in adults

Surgery Today ◽  
1995 ◽  
Vol 25 (2) ◽  
pp. 119-124 ◽  
Author(s):  
Bruno Andreoni ◽  
Aldo Marini ◽  
Maurizio Gavinelli ◽  
Roberto Biffi ◽  
Giorgio Tiberio ◽  
...  
Keyword(s):  
Emergency Management ◽  
Caustic Ingestion

Caustic Ingestion and Management of Esophageal Injury

1995 ◽  
Vol 112 (5) ◽  
pp. P121-P121
Author(s):  
Lauren D. Hounger
Keyword(s):  
Emergency Management ◽  
Surgical Management ◽  
Rational Approach ◽  
Esophageal Injury ◽  
Caustic Ingestion ◽  
Educational Objectives ◽  
Radiologic Evaluation

Educational objectives: To develop a rational approach to the management of this problem once an apparent ingestion of a caustic substance has occurred and to understand emergency management, radiologic evaluation, endoscopy, and medical and surgical management of caustic ingestion.

Dilation of Esophageal Strictures: Comparative Morbidity of Antegrade and Retrograde Methods

1988 ◽  
Vol 97 (5) ◽  
pp. 460-465 ◽  
Author(s):  
Donald B. Hawkins
Keyword(s):  
Operating Room ◽  
Esophageal Perforation ◽  
Caustic Ingestion ◽  
Successful Method ◽  
Esophageal Strictures

A total of 687 dilations of esophageal strictures were performed on 59 patients in the operating room over a 17-year period. Seventy-nine percent of the strictures were secondary to caustic ingestion and 89% of the dilations were in these patients. Antegrade dilations were performed 389 times and retrograde dilations were performed 298 times. Esophageal perforation occurred seven times with antegrade dilations. There were no perforations with retrograde dilations. The retrograde method using Tucker bougies is the safest and most successful method of dilating severe strictures.

Caustic injury of the oesophagus. Sixteen years experience, and introduction of a new model oesophageal stent

1996 ◽  
Vol 110 (11) ◽  
pp. 1041-1045 ◽  
Author(s):  
R. N. P. Berkovits ◽  
C. E. Bos ◽  
F. A. Wijburg ◽  
J. Holzki
Keyword(s):  
Silicone Oil ◽  
Caustic Ingestion ◽  
Stricture Formation ◽  
Not Given ◽  
Caustic Injury ◽  
Life Saving ◽  
Caustic Lesions ◽  
Oesophageal Stenosis ◽  
Oesophageal Stent

AbstractCaustic ingestion can lead to oesophageal stenosis. We studied 251 patients, 205 of whom were children, in a sixteen-year period. Seventeen patients, of whom one was an adult, acquired deep burns in the oesophagus which had to be treated, to prevent the development of oesophageal strictures. These patients were treated with long-term stenting of the oesophagus with specially designed, silicone rubber stents, impregnated with silicone oil 20 cS, designed by one of us (R.N.P.B.) as the only treatment. Of all models, the twin-tube dilatator was the most satisfactory. No corticosteroids were administered. Only one patient developed a mild stenosis. It is therefore our opinion that, when life-saving operations are not indicated, twin-tube stenting of the oesophagus is helpful in treating caustic lesions of the oesophagus and will prevent stricture formation. Corticosteroids were not given in this series, and should be abandoned in the treatment of caustic lesions.

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