Abstract
Background
Caustic ingestion causes a wide spectrum of injuries; appropriate treatment varies according to the severity and extent of the injury. This retrospective study of adult patients with caustic injury presents the endoscopic findings, treatment regimen, and clinical outcome.
Methods
Over a 28-year period, 95 consecutive adult patients admitted to an urban emergency hospital for ingestion of caustic materials were studied. Each patient underwent early endoscopy and the injury was graded for severity. There were 61 men and 34 women with an average age of 37.2 years (range 17 to 81). Ingestion was due to a suicide attempt in 49 patients and accidental in 46 patients.
Results
Ten patients showed no mucosal damage. The remaining 85 patients had grade I superficial injury in 47 patients, grade II moderate injury in 25 patients, and deep grade III injury in 13 patients. The ingestion of strong acid or strong alkali often produced deep grade III changes while bleach, detergent, ammonia or other substances usually caused grade I injury. Operative interventions were required for 11 patients with grade III injury and 6 patients with grade II injury. Endoscopic grading was predictive for the onset of complications including late esophageal stricture. There were no complications due to endoscopy; one patient with grade III and multiple comorbidities died from multiple organ failure.
Conclusion
Upper gastrointestinal endoscopy after caustic ingestion should be performed early to define the extent of injury and guide appropriate therapy. Grade I injuries heal spontaneously. Grade II injuries may be treated conservatively but repeat endoscopy helps define when intervention is needed. Grade III injuries ultimately require surgical intervention.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Leape LL, Ashcraft KW, Scarpelli DG, Holder TM (1971) Hazard to health – liquid lye. N Engl J Med 248:578–81
Walton WW (1982) An evaluation of the poison prevention packaging act. Pediatrics 69:363–70
Loeb PM, Eisenstein AM (1989) Caustic injury to the upper gastrointestinal tract. In: Sleisenger MH, Fordtran JS eds. Gastrointestinal disease. Philadelphia: WB Saunders, pp 203–10
Neimark S, Rogers AI (1985) Chemical injury of the esophagus. In: Bockus HL ed. Gastroenterology. Philadelphia: WB Saunders, pp 769–76
Borja AR, Ransdell HT Jr, Thomas TV, Johnson W (1969) Lye injuries of esophagus; Analysis of ninety cases of lye ingestion. J Thorac Cardiovasc Surg 57:533–58
Sugawa C, Mullins RJ, Lucas CE, Leibold WC (1981) The value of early endoscopy following caustic ingestion. Surg Gynecol Obstet 53:553–6
Havanond C (2003) Clinical features of corrosive ingestion. J Med Assoc Thai 86:918–24
Turner A, Robinson P (2005) Respiratory and gastrointestinal complications of caustic injury in children. Emerg Med J 22:359–61
Gaudreault P, Parent M, McGuigan MA, Choicoine L, Lovejoy FH (1983) Predictability of esophageal injury from signs and symptoms. A study of caustic ingestion in 378 children. Pediatrics 71:767–70
Cello JP, Fogel RP, Bolend R (1980) Liquid caustic ingestion spectrum of injury. Arch Intern Med 140:501–7
Poley JW, Steyerberg EW, Kuipers EJ, Dees J, Hartmans R, Tilanus HW, Siersema PD (2004) Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc 60:372–7
Ertekin C, Alimoglu O, Akyildiz H, Guloglu R, Taviloglu K (2004) The results of caustic ingestions. Hepatogastroenterology 51:1397–400
Mattos GM, Lopes DD, Mamede RCM, Ricz H, Mello-Filho FV, Neto JB (2006) Effects of time of contact and concentration of caustic agent on generation of injuries. Laryngoscope 116:456–60
Karjoo M (1998) Caustic ingestion and foreign body in the gastrointestinal system. Curr Opin Pediatr 10:516–22
Lovejoy FH (1990) Corrosive injury of the esophagus in children: failure of corticosteroid treatment reemphasizes prevention. N Engl J Med 323:668–70
Oakes DD (1995) Reconsidering the diagnosis and treatment of patients following ingestion of liquid lye. J Clin Gastroenterol 21:85–6
Havanond C (2002) Is there a difference between the management of grade 2b and 3 corrosive gastric injuries? J Med Assoc Thai 85:340–4
Andreoni B, Farina ML, Biffi R, Crosta C (1997) Esophageal perforation and caustic injury: Emergency management of caustic ingestion. Dis Esophagus 10:95–100
Tseng YL, Wu MH, Lin MY, Lai WW (2002) Early surgical correction for isolated gastric stricture following acid corrosion injury. Dig Surg 19:276–80
Tekant G, Eroglu E, Erdogan E, Yesildag E, Emir H, Buyukunal C, Yeker D (2001) Corrosive injury-induced gastric outlet obstruction: a changing spectrum of agents and treatment. J Pediatr Surg 36:1004–7
Baskin D, Urganci N, Abbasoglu L, Alkim C, Yalcin M, Karadag C, Sever N (2004) A standardized protocol for acute management of corrosive ingestion in children. Pediatr Surg Int 20:824–8
Broto J, Asensio M, Jorro CS, Gil Vernet CMJM, Acosta D, Ochoa JB (1999) Conservative treatment of caustic esophageal injuries in children: 20 years of experience. Pediatric Surg Int 15:323–5
Hopkins RA, Postlethwait RW (1981) Caustic burns and carcinoma of the esophagus. Ann Surg 194:146–8
Dantas RO, Mamede RCM (1996) Esophageal motility in patients with esophageal caustic injury. Am J Gastroenterol 91:1157–61
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tohda, G., Sugawa, C., Gayer, C. et al. Clinical evaluation and management of caustic injury in the upper gastrointestinal tract in 95 adult patients in an urban medical center. Surg Endosc 22, 1119–1125 (2008). https://doi.org/10.1007/s00464-007-9620-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9620-2