Abstract
Oesophageal strictures developing after caustic ingestion in children are a serious problem, and several protocols to prevent stricture formation have been proposed. A prospective clinical trial was conducted for preventing strictures in caustic oesophageal burns in a single clinic, and the results are presented. All children with caustic ingestion who had oesophagoscopy for diagnosing the severity of the burn were included in the study. Eighty-one children were included in the series, with ages ranging between 3 months and 12 years. The patients were given nothing by mouth until oesophagoscopy. IV fluids, broad-spectrum antibiotics, ranitidine, and a single-dose steroid were given. Oral burns were positive in 66 patients. Oesophagoscopy revealed a normal oesophagus in nine patients, grade 1 burn in 24, grade 2a in 21, grade 2b in 23, grade 3a in two, and grade 3b in one. Patients with grade 1 and 2a burns were discharged after oesophagoscopy. Patients with grade 2b and all grade 3 burns were given nothing by mouth for a week except water when swallowing their saliva, and were fed via total parenteral nutrition. After the 1st week, if there was no problem with swallowing, liquid foods were introduced. No intraluminal tubes were used. At the end of the 3rd week, a barium meal was administered and an upper gastrointestinal series taken. Dilatation was performed at 2-week intervals for strictures, which developed in one grade 2a patient, six grade 2b patients, and the grade 3b patient. Only one of these patients is currently on an oesophageal dilatation program. Limiting oral intake and avoiding foreign bodies in the oesophagus seem to provide a good success rate; however, further prospective studies are needed to decrease the incidence of corrosive oesophageal strictures.
Similar content being viewed by others
References
Anderson KD, Rouse TM, Randolph JG. (1990) A controlled trial of corticosteroids in children with corrosive injury of the esophagus. N Engl J Med 323:637–640
Ashcraft KW (2000) The esophagus. In: Ashcraft KW (ed) Pediatric surgery, 3rd edn. WB Saunders, Philadelphia, pp 325–347
Bautista Casasnovas A, Estevez Martinez E, Varela Cives R, Villanueva Jeremias A, Tojo Sierra R, Cadranel S (1997) A retrospective analysis of ingestion of caustic substances by children. Ten year statistics in Galicia. Eur J Pediatr 156:410–414
Broto J, Asensio M, Soler Jorro C, Marhuenda C, Gil Vernet JM, Acosta D, Boix Ochoa J (1999) Conservative treatment of caustic esophageal injuries in children: 20 years of experience. Pediatr Surg Int 15:323–325
Cecconello I, Zilberstein B, Pinotti HW (1995) Upper gastrointestinal sequelae due to ingestion of corrosives. In: Wastell C, Nyhus LM, Donahue PE (eds) Surgery of the esophagus, stomach and small intestine, 5th edn. Little, Brown and Company, Boston, pp 318–326
Cohen IK, Diegelmann RF, Yager DR, Wornum III IL, Graham MF, Crossland MC (1999) Wound care and wound healing. In: Schwartz SI (ed) Principles of surgery, 7th edn. McGraw-Hill, New York, pp 263–296
Huang YC, Ni YH, Lai HS, Chang MH (2004) Corrosive esophagitis in children. Pediatr Surg Int 20:207–210
Lamireau T, Rebouissoux L, Denis D, Lancelin F, Vergnes P, Fayon M (2001) Accidental caustic ingestion in children: is endoscopy always mandatory? J Pediatr Gastroenterol Nutr 33:81–84
Mamede RC, De Mello Filho FV (2002) Treatment of caustic ingestion: an analysis of 239 cases. Dis Esophagus 15:210–213
Marie JP, Dehesdin D, De Sevin E, Andrieu-Guitrancourt J (1992) Management of caustic burns of the esophagus in children. Ann Pediatr (Paris) 39:495–500
Millar AJW, Cywes S (1998) Caustic strictures of the esophagus. In: O’Neill JAO, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG (eds) Pediatric surgery, 5th edn. Mosby, St Louis, pp 969–679
Miller KA, Dudgeon DL (2003) Caustic esophageal injuries and perforations. In: Ziegler MM, Azizkhan RG, Weber TR (eds) Operative pediatric surgery. McGraw-Hill, New York, pp 341–347
Mutaf O, Genç A, Herek O, Demircan M, Özcan C, Arıkan A (1996) Gastroesophageal reflux: a determinant in the outcome of caustic esophageal burns. J Pediatr Surg 31:1494–1495
Nunes AC, Romaozinho JM, Pontes JM, Rodrigues V, Ferreira M, Gomes D, Freitas D (2002) Risk factors for stricture development after caustic ingestion. Hepatogastroenterology 49:1563–1566
Ulman I, Mutaf O (1998) A critique of systemic steroids in the management of caustic esophageal burns in children. Eur J Pediatr Surg 8:71–74
Warden GD, Heimbach DM (1999) Burns. In: Schwartz SI (ed) Principles of surgery, 7th edn. McGraw-Hill, New York, pp 223–262
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Baskın, D., Urgancı, N., Abbasoğlu, L. et al. A standardised protocol for the acute management of corrosive ingestion in children. Ped Surgery Int 20, 824–828 (2004). https://doi.org/10.1007/s00383-004-1294-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00383-004-1294-4