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Gordon ES, Barfield E, Gold BD. Early management of acute caustic ingestion in pediatrics. J Pediatr Gastroenterol Nutr 2025; 80:537-548. [PMID: 39887462 DOI: 10.1002/jpn3.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/18/2024] [Accepted: 11/23/2024] [Indexed: 02/01/2025]
Abstract
This review is intended to provide an overview of currently available literature related to caustic ingestion in pediatric patients, including initial management considerations in symptomatic versus asymptomatic children, timing and necessity of endoscopic evaluations, and the use of various therapeutic interventions. Further, this review provides management considerations for children presenting for evaluation following caustic ingestion based on the best available evidence. Additional research is needed to develop conclusive pediatric guidelines that meet GRADE criteria for management of caustic ingestion in children.
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Affiliation(s)
- Elliott S Gordon
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Elaine Barfield
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York, USA
| | - Benjamin D Gold
- GI Care for Kids, LLD, Children's Center for Digestive Healthcare, Atlanta, Georgia, USA
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Ogei E, Kakooza J, Lewis CR. Caustic esophageal stenosis: A case report of endoscopic dilatation with nasogastric tubes. Clin Case Rep 2023; 11:e7208. [PMID: 37077721 PMCID: PMC10106932 DOI: 10.1002/ccr3.7208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023] Open
Abstract
The management of the esophageal strictures that may result from caustic ingestion has evolved over time, from surgical to endoscopic management. Dilation with nasogastric tubes may be a valuable alternative in places with limited resources.
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Affiliation(s)
- Esau Ogei
- St. Joseph's Kitovu Hospital MasakaMasakaUganda
| | | | - Catherine R. Lewis
- St. Joseph's Kitovu Hospital MasakaMasakaUganda
- Department of SurgeryEast Tennessee State UniversityJohnson CityTennesseeUSA
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Endoscopic Grading as a Predictor to Develop Strictures in Corrosive Esophagitis in Children. J Clin Med 2023; 12:jcm12041699. [PMID: 36836234 PMCID: PMC9964508 DOI: 10.3390/jcm12041699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/29/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION The incidence of corrosive esophagitis, also known as caustic esophagitis in children, is still increasing in developing countries, according to different clinical reports. Acids and alkalis are, in the same manner, involved in the pathogenesis of corrosive esophagitis in children. The aim of our study was to determine the incidence and endoscopic grading of corrosive esophagitis in a cohort of children from a developing country. MATERIALS AND METHODS We performed a retrospective analysis of all pediatric patients who were admitted for corrosive ingestion at Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca, over 10 years. RESULTS A total of 22 patients consisting of 13 (59.09%) girls and 9 boys (40.91%) were found in the present research. The majority of children lived in rural areas (69.2%). The results of laboratory tests were not well correlated with the degree of the injury. White blood cell counts over 20,000 cells/mm3, an increase in the C-reactive protein level and hypoalbuminemia were noticed only in three patients with strictures. The lesions were associated with increased levels of the pro-inflammatory cytokines, including interleukin (IL)-2, IL-5 and Interferon-gamma. Severe late complications such as strictures have been noticed in children with grade 3A injuries. The endoscopic dilation was done after the six months endoscopy. None of the patients treated with endoscopic dilation required surgical intervention for esophageal or pyloric perforation or dilation failure. The majority of complications (such as malnutrition) were noticed in children with grade 3A injuries. In consequence, prolonged hospitalization has been required. The second endoscopy (done six months after ingestion) revealed stricture as the most common late complication (n = 13, 60.60%: eight patients with grade 2B and five with grade 3A). CONCLUSION There is a low incidence of corrosive esophagitis in children in our geographic area. Endoscopic grading is a predictor of late complications such as strictures. Grade 2B and 3A corrosive esophagitis are likely to develop strictures. It is crucial to avoid strictures and to prevent malnutrition.
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Updates on the Evaluation and Management of Caustic Exposures. Emerg Med Clin North Am 2022; 40:343-364. [DOI: 10.1016/j.emc.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rouse S, Buckle A, Hebbard G, Metz A, Sood S. Caustic ingestions over 10 years in Victoria, Australia: High rates in migrants and women. Intern Med J 2021; 52:1185-1189. [PMID: 33710746 DOI: 10.1111/imj.15284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/03/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Caustic ingestion is relatively common in developing countries and can result in life-threatening sequelae. There is limited understanding of the epidemiology and incidence in Australia. This statewide 10 year audit aims to investigate this further. METHOD A retrospective review was conducted over ten years (2007-2016), including all admissions to hospitals in Victoria. This includes a population of 5.9 million people and 22 hospitals. RESULTS 384 cases of caustic ingestion were admitted to hospital between January 2007 and December 2016. The overall incidence was 7 cases/million/year. This cohort included 217 females (56.5%), 193 overseas born patients (50.2%) and 196 people (51%) with a history of mental illness. The countries of birth with the highest incidence of caustic ingestion were Ethiopia, 11 patients (227 cases/million/year, RR 31.7, p < 0.0001), Sudan, 11 patients (161 cases/million/year, RR 22.6, p < 0.0001), India, 38 patients (27 cases/million/year, RR 3.9, p < 0.0001). All had a significantly higher incidence than the Australian-born population of only 6.5 cases/million/year (RR 0.4, p < 0.0001). Of those born in India, Sudan and Ethiopia, rates of females were considerably higher than males (72% females). The overall mortality rate in this cohort was 2.3%. CONCLUSIONS Caustic ingestion remains a significant cause of morbidity and health expenditure in Victoria, particularly amongst vulnerable groups such as recent female migrants from areas in Africa and India. The high frequency of events seen in migrant populations highlights the significant need for awareness of risks in these groups for development of possible prevention strategies which are required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sarah Rouse
- Department of Gastroenterology and Hepatology, the Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew Buckle
- Department of Gastroenterology and Hepatology, the Royal Melbourne Hospital, Melbourne, Australia
| | - Geoff Hebbard
- Department of Gastroenterology and Hepatology, the Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Andrew Metz
- Department of Gastroenterology and Hepatology, the Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Siddharth Sood
- Department of Gastroenterology and Hepatology, the Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
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Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive substances ingestion: a review. Crit Rev Toxicol 2020; 49:637-669. [PMID: 32009535 DOI: 10.1080/10408444.2019.1707773] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Corrosive chemical substance ingestions are a major problem, especially in developing countries, but also in developed countries such as the United States, France, and Belgium. Ingestions may be deliberate as suicide attempts (mostly in adolescents and adults) or accidental (mostly in children). The results can be devastating in terms of individual suffering and disability, but also in terms of resource utilization and costs. In developing countries, outcomes may be worse because of limited medical/surgical resources. Common sequelae include gastrointestinal (GI) tract (esophagus, stomach, pylorus, and duodenum) stricture formation, GI tract perforation, and hemorrhage. Systemic effects may also occur, such as disseminated intravascular coagulation (DIC), multi-organ system failure, and sepsis. Various interventions in the acute phase to reduce the severity of injury have been attempted, but there are no large controlled clinical trials to demonstrate efficacy. Dilation therapy in various forms is commonly used for the treatment of strictures and a variety of surgical procedures including esophagectomy and delayed replacement may be required in severe corrosive injury cases.
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Affiliation(s)
- Alan H Hall
- Toxicology Consulting and Medical Translating Services, Azle and Springtown, TX, USA.,Colorado School of Public Health, University of Colorado-Denver, Denver, CO, USA
| | | | | | | | - Patrice Josset
- Department of Pathology, Hôpital d'Enfants Armand Trousseau, Director of the Teaching Program of the History of Medicine, Université Pierre et Marie Curie, Paris, France
| | - Bernard Meyer
- Department of Otorhinolaryngology, Université Pierre et Marie Curie, Groupe Hospitalier Pieté-Salpêtrière, Paris, France
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Acehan S, Satar S, Gulen M, Avci A. Evaluation of corrosive poisoning in adult patients. Am J Emerg Med 2020; 39:65-70. [PMID: 31982223 DOI: 10.1016/j.ajem.2020.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 01/07/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To evaluate the demographic characteristics, endoscopy results, emerging complications and the final status of caustic intake cases admitted to our emergency department. METHOD This study is a retrospective one concerning patients admitted to our emergency department due to caustic ingestion. Demographic characteristics of the patients, complaints while applying to the hospital, physical examination findings, the purpose of caustic intake, the characteristics of corrosive substance taken, times of endoscopy following admission to the emergency department, follow-up times in the emergency department, endoscopic staging and outcome. The data were analyzed through IBM SPSS Statistics Base 22.0 package program. RESULTS Seventy four patients participated in the study. 83.8% of corrosive substance intake cases were accidental and 16.2% cases were suicidal intention. While 60.8% of the corrosive substances taken had alkaline property, 36.5% were acidic and 2.7% were found to be unknown substances. 50% of the corrosive substance intakes were sodium hypochlorite. It was seen that endoscopy was performed in 59 patients who accepted endoscopy within an average of 244.07 min after admission to the emergency department. While no damage could be seen in 55.9% of patients following endoscopy, the most common injury was Grade 1 (35.6%). CONCLUSION Corrosive substance intake is a rare but potentially devastating poisoning with high morbidity and mortality. Mucosal injury begins within minutes following corrosive intake. Therefore, early endoscopy is helpful in assessing the degree of injury and early discharge from hospital.
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Affiliation(s)
- Selen Acehan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey.
| | - Salim Satar
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Muge Gulen
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Akkan Avci
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
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Slaughter RJ, Watts M, Vale JA, Grieve JR, Schep LJ. The clinical toxicology of sodium hypochlorite. Clin Toxicol (Phila) 2019; 57:303-311. [PMID: 30689457 DOI: 10.1080/15563650.2018.1543889] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Martin Watts
- National Poisons Centre, University of Otago, Dunedin, New Zealand
- Emergency Department, Southland Hospital, Invercargill, New Zealand
| | - J. Allister Vale
- West Midlands Poisons Unit, City Hospital, and University of Birmingham, Birmingham, UK
| | | | - Leo J. Schep
- National Poisons Centre, University of Otago, Dunedin, New Zealand
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Methasate A, Lohsiriwat V. Role of endoscopy in caustic injury of the esophagus. World J Gastrointest Endosc 2018; 10:274-282. [PMID: 30364838 PMCID: PMC6198306 DOI: 10.4253/wjge.v10.i10.274] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/06/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023] Open
Abstract
Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Although the caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable role in diagnosis and treatment. Endoscopy can determine the severity of caustic ingestion which is of great importance in choosing appropriate treatment. However, some aspects of endoscopy in diagnosis of caustic injury remain controversial. Whether or not all patients need endoscopy, when to perform endoscopy and how to assess the severity are just some examples of these controversies. Due to lack of randomized controlled trials, many findings and suggestions are inconclusive. Computerized tomography scan of the chest and abdomen gains popularity in assessing the severity of caustic injury and avoiding unnecessary surgery. If esophageal stricture eventually develops, endoscopic dilatation is a mainstay. Maneuvers such as steroid injection and esophageal stent may be used in a refractory stricture. Nevertheless, some patients have to undergo surgery in spite of vigorous attempts with esophageal dilatation. To date, caustic injury remains a difficult situation. This article reviews all aspects of caustic injury of the esophagus focusing on endoscopic role. Pre-endoscopic management, endoscopy and its technique in acute and late phase of caustic injury including the endoscopic management of refractory stricture, and the treatment outcomes following each endoscopic intervention are thoroughly discussed. Finally, the role of endoscopy in the long term follow-up of patients with esophageal caustic injury is addressed.
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Affiliation(s)
- Asada Methasate
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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10
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Intentional Ingestion of Hydrogen Peroxide. Trauma Mon 2018. [DOI: 10.5812/traumamon.65808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hashmi MU, Ali M, Ullah K, Aleem A, Khan IH. Clinico-epidemiological Characteristics of Corrosive Ingestion: A Cross-sectional Study at a Tertiary Care Hospital of Multan, South-Punjab Pakistan. Cureus 2018; 10:e2704. [PMID: 30062078 PMCID: PMC6063384 DOI: 10.7759/cureus.2704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Corrosive ingestion is a grave public health problem. It is a medical emergency and shows diverse clinical presentations. The ingestion of corrosive substances has devastating effects on upper gastrointestinal and respiratory tracts and the corrosive injury is associated with numerous life-threatening complications. The present study aims to explore the clinico-epidemiological characteristics of patients of corrosive ingestion presenting at a tertiary care hospital of Multan, Pakistan. Method The target study population consists of all the patients with primary diagnosis of corrosive ingestion who presented to the department of thoracic surgery, Nishtar Medical University Hospital Multan, Pakistan, from January 2016 to December 2017. The follow-up cases and the cases with ingestion of substances other than corrosives were not included in the study. All the included cases were evaluated by detailed history, thorough physical examination and the necessary investigations. The post-cor-rosive tissue damage was classified accord-ing to Zargar's classification system. All the demographic data and other variables were measured and recorded using a Performa. The data were analyzed by using computer program SPSS 21 version. Results The total study population was 206 patients. There were 135 females (65.5%) and 71 male patients (34.5%). Age ranged from 2 to 42 years (mean 23.44 ± 7.19). Only seven cases were found in the age group of 2-7 years. The residents of rural areas showed a slightly increased inclination towards corrosive ingestion. One hundred and ten cases were unmarried (53.4%) while 90 patients were married (43.7%). The incidence of corrosive ingestion was much high in illiterate/less educated patients belonging to the groups of lower socio-economic status. One hundred and ninety-seven patients ingested corrosive substances deliberately with the suicidal intention (95.6%). The acid used as bathroom cleaner and the laundry bleaches were the most commonly used corrosive agents. In 166 cases the corrosive materials were already present at home for domestic purposes (80.6%), but 18 subjects particularly purchased these corrosive substances to commit suicide. The quantity of ingested material ranged between 10 ml and 150 ml with a mean of 42.6 ml ± 33.2. The shortest hospital stay was one day, and the longest one was 60 days. Esophagus and oropharyngeal area were the most common site which sustained the corrosive injury, whereas corrosive injury to duodenum was least frequent (34.5 %). Conclusion Corrosive ingestion is a serious medical problem and it requires a multidisciplinary approach and a good coordination between different medical specialists. Underprivileged teenager females of rural areas are more likely to ingest corrosive materials with suicidal intention. In most of the ingestions, household cleaning products are used. Only the patients with severe corrosive injury should be admitted to intensive care units. Enforcing regulations for the manufacturers of household cleaning products can significantly reduce the incidence of this potentially fatal condition.
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Affiliation(s)
| | - Mansoor Ali
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Kaleem Ullah
- Upper Gi and Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Abdul Aleem
- Thoracic Surgery, Nishtar Medical University Hospital, Multan, PAK
| | - Iftikhar H Khan
- Thoracic and General Surgery, Nishtar Medical University, Multan, PAK
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Chibishev A, Bozinovska C, Gulabovski R. Clinical evaluation and management of acute corrosive poisoning in adult patients - A ten year experience. Am J Emerg Med 2018; 36:328-329. [DOI: 10.1016/j.ajem.2017.07.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 01/06/2023] Open
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Rumbach AF, Cremer R. Dysphagia and Speech-Language Pathology Involvement Following Chemical Ingestion Injury: A Review of 44 Cases Admitted to a Quaternary Australian Hospital (2008-2012). AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:1120-1128. [PMID: 28800373 DOI: 10.1044/2017_ajslp-16-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This study aimed to explore the clinical characteristics of an adult chemical ingestion population and examine the course of return to oral intake post injury and speech-language pathologist (SLP) involvement during the initial acute-care admission. METHOD A retrospective chart review of adults admitted to a quaternary hospital for the treatment of an acute chemical ingestion injury between 2008 and 2012 was conducted. RESULTS Forty-four adults (23 men, 21 women) were identified as receiving treatment for ingestion injury, of whom 18 (40.91%) required altered oral intake. Of those requiring altered oral intake, 50% were referred to SLPs. Individuals requiring altered oral intake were significantly (p < .05) older, more likely to be men, and present with more severe injuries requiring longer ICU and hospital admissions following intentional chemical ingestions than those who were able to commence a normal oral diet without any alteration or nonoral supplementation. By discharge, 15.91% (n = 7) of the total cohort had not resumed normal oral intake. CONCLUSIONS Return to oral intake post chemical ingestion injury can be protracted and complex. Referrals to SLPs were limited. These data may aid prognostic insight as well as provide (a) collateral information to assist discharge planning and follow-up and (b) background for evaluating the potential for SLP involvement.
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Affiliation(s)
- Anna F Rumbach
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca Cremer
- Speech Pathology Department, Royal Brisbane and Women's Hospital, Metro North Hospital Health Service, Queensland Health, Brisbane. Australia
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Abbas A, Brar TS, Zori A, Estores DS. Role of early endoscopic evaluation in decreasing morbidity, mortality, and cost after caustic ingestion: a retrospective nationwide database analysis. Dis Esophagus 2017; 30:1-11. [PMID: 28475747 DOI: 10.1093/dote/dox010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 01/26/2017] [Indexed: 12/11/2022]
Abstract
Caustic substance ingestion (CSI) is a serious medical problem with potentially devastating short- and long-term consequences. Early upper gastrointestinal endoscopy (EaEn) is recommended to evaluate the extent of injury and guide management but there has been controversy about the timing. There is no nationwide study evaluating adherence to EaEn and outcomes following CSI.Nationwide Inpatient Sample database 2003-2011 was used to identify all-age, nonreferral, urgent/emergent admissions with E-International Classification of Diseases Ninth Revision codes for CSI. We evaluated the association of undergoing late endoscopy (LaEn, >48 hours since admission) with poor clinical (death or systemic complications) and economic (cost for admission and length of stay above the 75th percentile) outcomes after controlling for other demographic and clinical factors using a multivariate analysis.We identified 21,682 patients with a median age of 37 years, 51% males, 43% Caucasians, with suicidal ingestion reported in 40%. Endoscopy was performed in 6011 patients (37%). The majority had EaEn (43% within 24, and 40% within 24-48 hours), whereas 17% had LaEn.Compared to EaEn group, the LaEn group was associated with a three-fold increase (OR = 2.7, P < 0.001) in the risk for poor clinical outcome: a fourfold increase (OR = 4.6, P < 0.001) in high cost admissions, and a fivefold increase (OR = 4.9, P < 0.001) in prolonged hospitalization. There was no significant difference in clinical outcomes based on endoscopy within 24, and 24-48 hours of admission.In this retrospective nationwide database analysis, undergoing LaEn was associated with both negative clinical and economic outcomes. More studies are needed to further examine the reasons for delaying endoscopy and subsequent management pathways based on the endoscopic findings. Early endoscopic evaluation could potentially improve the clinical outcomes and reduce costs of these admissions.
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Affiliation(s)
| | | | - A Zori
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - D S Estores
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
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De Lusong MAA, Timbol ABG, Tuazon DJS. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther 2017; 8:90-98. [PMID: 28533917 PMCID: PMC5421115 DOI: 10.4292/wjgpt.v8.i2.90] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 02/25/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and pH of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.
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Badrane N, Jalal G, Soussi Tanani D, Soulaymani A, Rhalem N, Soulaymani-Bencheikh R. Les intoxications aiguës par l’acide chlorhydrique : données du Centre anti-poison et de pharmacovigilance du Maroc, 1980–2011. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2016. [DOI: 10.1016/j.toxac.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Radenkova-Saeva J, Loukova A, Tsekov C. Caustic Injury In Adults – A Study For 3 Year Period. ACTA MEDICA BULGARICA 2016. [DOI: 10.1515/amb-2016-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
The aim of the study is to present the results of a 3-year clinico-epidemiological investigation of caustic injury in adults. The study includes 43 patients with acute corrosive ingestion, hospitalized in the Toxicology Clinic, University Hospital “N. I. Pirogov”, Sofia, Bulgaria, for the period 01.01. 2010-31.12.2012. The methods used include: clinical observation and examination, clinical laboratory, imaging, and psychiatric methods and tests. 43 patients between the ages of 22 and 82 with acute corrosive ingestions have been observed. Eleven were male (25.6%) and 32 female (74.4%). All ingestions were intentional. Alkaline agents were used by all of the patients. The severity of poisonings varied from moderate to extremely severe. Different complications were seen in 82% of the cases - severe bleeding, perforation, fistula or/and stricture formation. Two of the patients have undergone surgical intervention - coloesophagoplastic - and have recovered completely. The motivation in different age groups was also studied. Psychiatric comorbidity occurred in patients as depressive and schizoaffective disorder, as well as existential crises. Acute corrosive ingestions by alkaline agents cause severe pathology. The severity and complex character of the injuries require good coordination between different medical specialists.
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Affiliation(s)
- J. Radenkova-Saeva
- Clinic, University Hospital “N. I. Pirogov”, 21 Totleben Blvd. Bg - 1606 Sofia, Bulgaria
| | - A. Loukova
- Toxicology Clinic, University Hospital “N. I. Pirogov”, Sofia, Bulgaria
| | - Ch. Tsekov
- Division of Surgery, National Transport Hospital, Sofia, Bulgaria
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Swain R, Behera C, Gupta SK. Fatal corrosive ingestion: A study from South and South-East Delhi, India (2005-2014). MEDICINE, SCIENCE, AND THE LAW 2016; 56:252-257. [PMID: 27400703 DOI: 10.1177/0025802416657762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The study presents a retrospective analysis of 64 cases of death resulting from ingestion of corrosive substances. The cases represented approximately 0.4% of all autopsies conducted and 13.6% of all fatal poisonings studied during the 10-year period from January 2005 to December 2014 at the Department of Forensic Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi. The data was analyzed with regard to age, sex, nature and source of corrosive substance used, survival period, cause and manner of death. Males (64.06%) outnumbered females (35.94%), with a male-to-female ratio of 1.78:1. The most common age group involved was 21-30 years (35.94%). Sulfuric acid (68.75%) presented as the most common corrosive substance ingested. Household cleaning substances (39.06%) were identified as a common source of such type of corrosive substance, but the exact source could not be identified in 56.26% of cases. In the majority of cases (46.88%) death was due to perforation peritonitis. Most of the victims (54.69%) succumbed to their injuries within a day of ingestion. In 87.5% of cases, the corrosive substance was consumed for suicidal purposes. A strict regulatory framework is required for the production, distribution, storage and use of corrosive substances. Preventive guidelines and creating awareness among the masses will go a long way towards curbing such unfortunate incidents.
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Affiliation(s)
- Rajanikanta Swain
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Chittaranjan Behera
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sudhir Kumar Gupta
- Department of Forensic Medicine & Toxicology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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A Nationwide Population-Based Study of Corrosive Ingestion in Taiwan: Incidence, Gender Differences, and Mortality. Gastroenterol Res Pract 2015; 2016:7905425. [PMID: 26819610 PMCID: PMC4706953 DOI: 10.1155/2016/7905425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/31/2015] [Accepted: 08/31/2015] [Indexed: 12/30/2022] Open
Abstract
Corrosive injury results from the intake of corrosive-acid-based chemicals. However, this phenomenon is limited to a small number of cases and cannot be extrapolated to the epidemiology of corrosive injuries in actual situations. This study focuses on the annual incidence of corrosive injury and its connection to gender, risk factors, and in-hospital mortality. All patients with corrosive injury (ICD-9 947.0–947.3) were identified using a nationwide inpatient sample from 1996 until 2010. Chi-squared tests and multivariate logistic regression were used to examine risk factors of gender differences and in-hospital mortality of corrosive injury. Young adults comprised the majority of patients (71.2%), and mean age was 44.6 ± 20.9 years. Women showed a higher incidence rate of corrosive injuries, age, suicide, psychiatric disorder, and systemic complications compared with men (p < 0.001). The present study demonstrated that age (OR = 10.93; 95% CI 5.37–22.27), systemic complications (OR = 5.43; 95% CI 4.61–6.41), malignant neoplasms (OR = 2.23; 95% CI 1.37–3.62), gastrointestinal complications (OR = 2.02; 95% CI 1.63–2.51), chronic disease (OR = 1.30; 95% CI 1.08–1.56), and suicide (OR = 1.23; 95% CI 1.05–1.44) were strongly associated with in-hospital mortality. Educational programs may be helpful for reducing the incidence of ingestion of corrosive chemicals.
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Amadasi A, Gentile G, Rancati A, Zoja R. Macroscopic and histopathological aspects of chemical damage to human tissues depending on the survival time. Int J Legal Med 2015; 130:743-9. [PMID: 26384506 DOI: 10.1007/s00414-015-1265-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 09/10/2015] [Indexed: 12/31/2022]
Abstract
The ingestion of corrosive substances is a widely treated topic in clinical and forensic practice, as an accidental event or as a consequence of voluntary assumption to commit suicide. However, thorough macroscopic and microscopic surveys focused on the correlation between the ingestion of the substance and different survival times have never been performed. Are the ingestion and the metabolism of the substance within the human tissues still recognizable? How could it be related to death? The study concerns a retrospective analysis on ten cases (two accidental, eight suicides) of lethal ingestion of different types of liquid caustic substances, without instant death and survival times ranging from 12 h to 6 months. For each case, a full autopsy and histological examination of the internal organs were performed. The results showed that the early direct effect of the substances is exerted mainly on the gastrointestinal tract, but as survival time increased, the metabolism of the substance exerted its effects in different target organs. When the cause of death was not directly linkable to the ingestion of the substance (i.e., related to cardiac stress, electrolyte disorders, pneumonia) and macroscopic findings were nonspecific, histological analyses allowed for providing crucial elements towards a link between death and assumption of the substance.
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Affiliation(s)
- Alberto Amadasi
- Sezione di Medicina Legale e delle Assicurazioni - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy.
| | - Guendalina Gentile
- Sezione di Medicina Legale e delle Assicurazioni - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy
| | - Alessandra Rancati
- Sezione di Medicina Legale e delle Assicurazioni - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy
| | - Riccardo Zoja
- Sezione di Medicina Legale e delle Assicurazioni - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Luigi Mangiagalli 37, Milano, Italy
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Song HK, Shim KN, Yun HW, Tae CH, Kim SE, Jung HK, Jung SA, Yoo K. [Caustic injury of upper gastrointestinal tract: 20 year experience at a tertiary referral center]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2015; 65:12-20. [PMID: 25603849 DOI: 10.4166/kjg.2015.65.1.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIMS Caustic ingestion can cause severe injury to upper gastrointestinal tract. There were few studies about clinical characteristics and treatments of caustic injury in Korea. We investigated the changes in clinical features of caustic injury over the past 20 years including pattern of endoscopic mucosal injury and treatment modality. METHODS This study was a retrospective review of medical records from patients with caustic injury from September 1993 through December 2012. Patients were classified into two groups based on the year when caustic ingestion occurred: patients who visited the hospital from 1993 to 2002 (early group) and patients who visited the hospital from 2003 to 2012 (late group). RESULTS A total 140 patients were included (early group [n=50] vs. late group [n=90]). Annual number of caustic ingestions did not show decreasing tendency over the past 20 years. Alkali ingestion increased (20.0% vs. 65.6%, p<0.001) and cases with more than grade 2b of esophageal mucosal injury decreased (41.3% vs. 20.7%, p=0.012) in late group. There were no differences between two groups in sex, age, proportion of accidental ingestion, and systemic/gastrointestinal complications. Use of gastric lavage (p<0.01) and broad spectrum antibiotics (p=0.03) decreased in late group. However, there was no difference in use of steroid between two groups. CONCLUSIONS In this study, overall caustic ingestion did not decrease and ingestion of alkali agents increased over the past 20 years. Tighter legislation on caustic agents is required and we need to be alert to the best management of caustic injury.
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Affiliation(s)
- Hye Kyung Song
- Department of Health Promotion Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Korea
| | - Ki Nam Shim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye Won Yun
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Seong Eun Kim
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hye Kyung Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Ae Jung
- Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kwon Yoo
- Department of Health Promotion Medicine, Ewha Womans University Medical Center Mokdong Hospital, Seoul, Korea
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Chibishev A, Glasnovic M, Miletic M, Smokovski I, Chitkushev L. Influence of age on the survival and mortality rate in acute caustic poisonings. Mater Sociomed 2014; 26:272-6. [PMID: 25395893 PMCID: PMC4214801 DOI: 10.5455/msm.2014.26.272-276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/25/2014] [Indexed: 01/21/2023] Open
Abstract
Objective: Acute poisonings with caustic substances can cause severe chemical injuries to the upper gastrointestinal tract, which can be localized from the mouth to the small intestines. They are seen very often among young people in their most productive years. The aim of this study is to examine the influence of patient’s age on the mortality rate and survival of patients with acute caustic poisonings, and also to analyze their correlation. Material and Methods: We studied medical records from 415 patients, aged between 14 and 90 years, who were hospitalized and treated at the University Clinic for toxicology and urgent internal medicine, Skopje, Republic of Macedonia, in the period between 2007 and 2011. Results: In the survey we included 415 patients with acute corrosive poisonings, from which 295 (71.08%) were females and 120 (28. 92%) were males. 388 (93.49%) from the total number of patients ingested the corrosive agent with suicidal attempt and 27 (6.5%) ingested it accidentally. Conclusion: Unregulated production, import, packing and labeling of various caustic agents, due to inappropriate legislative, made them one of the most often abused substances in everyday life, especially in developing countries where the number of caustic poisonings rises.
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Affiliation(s)
- Andon Chibishev
- University Clinic of Toxicology, Clinical Center, University "Ss Cyril and Metodius", Medical faculty, Skopje, Republic of Macedonia
| | - Marija Glasnovic
- University Clinic of Toxicology, Clinical Center, University "Ss Cyril and Metodius", Medical faculty, Skopje, Republic of Macedonia
| | - Milena Miletic
- University Clinic of Toxicology, Clinical Center, University "Ss Cyril and Metodius", Medical faculty, Skopje, Republic of Macedonia
| | - Ivica Smokovski
- University Clinic of Toxicology, Clinical Center, University "Ss Cyril and Metodius", Medical faculty, Skopje, Republic of Macedonia
| | - Lou Chitkushev
- Boston University, Health Informatics Lab, Metropolitan College, Boston, MA, USA
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Bonnici KS, Wood DM, Dargan PI. Should computerised tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances? Clin Toxicol (Phila) 2014; 52:911-25. [PMID: 25224219 DOI: 10.3109/15563650.2014.957310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Corrosive ingestions are common, although most ingestions do not result in clinically significant effects. Limited guidance is available on the role of endoscopy and/or computerised tomography (CT) in the investigation of individuals with corrosive ingestion, and the present data regarding predictors of poor outcome are confusing. Furthermore, whilst there are many case series describing the use of endoscopy in corrosive ingestions, no clear ideal time frame has been established as to when it should be undertaken. More recently, CT has been used to grade injuries, but there are few studies on its role in managing corrosive injuries, and those studies that have been reported are conflicting in their results. METHODS A Medline search was performed with the terms 'Caustic ingestion' and 'Corrosive ingestion' and a second search by adding the words 'Endoscopy', 'CT', and 'Computerised tomography' as a subject term or keyword. These searches revealed a total of 277 reviews and papers, of which 33 original papers were relevant for analysis. Three further papers were identified during the analysis of these papers and a PubMed search of the same terms added one further paper, bringing the total to 37. There have been no prospective, randomised controlled trials directly comparing endoscopy and CT. Only two retrospective studies compared the use of CT and that of endoscopy. Thirty-five studies examined whether an endoscopy is always needed, and if so, within what time frame this should be done: CT or endoscopy? A review of these studies suggests that the data regarding the use of CT in these circumstances are not yet of sufficient weight to replace endoscopy as the first-line investigation in corrosive ingestion-related injury. Who needs investigation after corrosive ingestion? We believe that signs and symptoms indicate the likelihood of clinically significant injury in adults. Specifically, any evidence of oropharyngeal burns, drooling, vomiting, pain or dysphagia clearly indicates the need for an endoscopy. In children, it appears that an even greater degree of caution is needed. How soon after ingestion should investigation be performed? For whom an endoscopy is required, it is prudent to enable surgery and other specifics regarding management of corrosives to be decided quickly (< 12 h). There are many incidences where endoscopy has been done safely beyond 48 h although this is not needed frequently. Management recommendations Asymptomatic patients, particularly adults with a normal clinical examination and who can eat and drink normally, can be discharged safely without endoscopy. Endoscopy is preferred over CT in the assessment of risk in symptomatic patients with corrosive ingestion. If patients have any oropharyngeal injury and in particular symptoms of drooling, vomiting, dysphagia or pain (retrosternal or otherwise), the risk of having a high-grade injury is higher, and urgent endoscopy should be performed to grade the injury and determine whether surgical intervention is required. Patients who have non-specific symptoms, such as cough, should also undergo endoscopy, but this is less urgent. CONCLUSIONS Despite the lack of high-quality clinical trial data, the available evidence and clinical experience support the use of early endoscopy (< 12 h) in patients who are symptomatic after ingestion of a corrosive substance. We propose a clinical guideline that can be used to help plan management of corrosives.
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Affiliation(s)
- K S Bonnici
- Department of Acute Medicine, Chelsea & Westminster Hospital NHS Trust , London , UK
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Agarwal A, Singh DK. Bronchoscopic topical steroid instillation in prevention of tracheal stenosis. J Anaesthesiol Clin Pharmacol 2014; 30:91-3. [PMID: 24574602 PMCID: PMC3927302 DOI: 10.4103/0970-9185.125712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Corrosive acid poisoning commonly results in chemical injuries to respiratory and upper gastrointestinal tract. Corrosive mucosal erosion of the larynx and trachea may occur if the patient aspirates acid. We successfully used local anti-inflammatory action of dexamethasone instilled through a fiber-optic bronchoscope for regression of mucosal edema and prevention of subsequent development of stricture in a young female.
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Affiliation(s)
- Ankit Agarwal
- Department of Anesthesiology and Critical Care, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - D K Singh
- Department of Anesthesiology and Critical Care, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
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Maignan M, Danel V. Prise en charge préhospitalière des intoxications aiguës graves. ANNALES FRANCAISES DE MEDECINE D URGENCE 2013. [DOI: 10.1007/s13341-013-0291-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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DiPoce J, Guelfguat M, DiPoce J. Radiologic Findings in Cases of Attempted Suicide and Other Self-Injurious Behavior. Radiographics 2012; 32:2005-24. [DOI: 10.1148/rg.327125035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Chibishev A, Pereska Z, Chibisheva V, Simonovska N. Corrosive poisonings in adults. Mater Sociomed 2012; 24:125-30. [PMID: 23678319 PMCID: PMC3633385 DOI: 10.5455/msm.2012.24.125-130] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/15/2012] [Indexed: 12/23/2022] Open
Abstract
Ingestion of corrosive substances may cause severe to serious injuries of the upper gastrointestinal tract and the poisoning can even result in death. Acute corrosive intoxications pose a major problem in clinical toxicology since the most commonly affected population are the young with psychic disorders, suicidal intent and alcohol addiction. The golden standard for determination of the grade and extent of the lesion is esophagogastroduodenoscopy performed in the first 12-24 hours following corrosive ingestion. The most common late complications are esophageal stenosis, gastric stenosis of the antrum and pyloris, and rarely carcinoma of the upper gastrointestinal tract. Treatment of the acute corrosive intoxications include: neutralization of corrosive agents, antibiotics, anti-secretory therapy, nutritional support, collagen synthesis inhibitors, esophageal dilation and stent placement, and surgery.
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Affiliation(s)
- Andon Chibishev
- University Clinic of Toxicology, Clinical Center Skopje, Republic of Macedonia
| | - Zanina Pereska
- University Clinic of Toxicology, Clinical Center Skopje, Republic of Macedonia
| | - Vesna Chibisheva
- University “Ss Cyril and Metodius”, Medical faculty, Skopje, Republic of Macedonia
| | - Natasa Simonovska
- University Clinic of Toxicology, Clinical Center Skopje, Republic of Macedonia
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Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, Liu NJ, Chen PC. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol 2008; 8:31. [PMID: 18655708 PMCID: PMC2533005 DOI: 10.1186/1471-230x-8-31] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 07/25/2008] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The ingestion of caustic substances induces an extensive spectrum of injuries to the aerodigestive tract which include extensive necrosis and perforation of the esophagus and stomach. The gold standard of safely assessing depth, extent of injury, and appropriate therapeutic regimen is esophagogastroduodenoscopy (EGD). The objective of this study was to report our clinical experience and to evaluate the role of a 6-point EGD classification system of injury in predicting outcomes in adult patients diagnosed with caustic agent ingestion. METHODS The study was a retrospective medical chart review from 273 patients admitted to the Chang Gung Memorial Hospital in Tao-Yuan, Taiwan between June 1999 and July 2006 for treatment of caustic ingestion. The patients underwent EGD within 24 hours of admission and mucosal damage was graded using Zagar's modified endoscopic classification scheme. After treatment, patients were followed in the outpatient clinic for a minimum of 6 months. RESULTS A total of 273 patients were included for analysis. Grade 3b injury was the most common caustic injury (n = 82, 30.03%), followed by grade 2b injuries (n = 62, 22.71%). Stricture was the most common complication (n = 66, 24.18%), followed by aspiration pneumonia (n = 31, 11.36%), and respiratory failure (n = 21, 7.69%). Compared to grade 3a mucosal injury, grade 3b mucosal injuries were at greater risk of prolonged hospital stay (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.25-4.80), ICU admission (OR: 10.82; 95% CI: 2.05-200.39), and gastrointestinal (OR: 4.15; 95% CI: 1.55-13.29) and systemic complications (OR: 4.07; 95% CI: 1.81-14.07). CONCLUSION In patients with caustic ingestion, EGD should be performed within 12 to 24 hours and categorized according to a 6-point scale. Patients with grade 3b burns identified on endoscopy have high rates of morbidity. The 6-point scale is useful for predicting immediate and long-term complications, and guiding appropriate therapy.
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Affiliation(s)
- Hao-Tsai Cheng
- Division of Digestive Therapeutic Endoscopy, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
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Accidental ingestion of 35% hydrogen peroxide. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2008; 21:665-7. [PMID: 17948137 DOI: 10.1155/2007/423217] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hydrogen peroxide is a commonly used oxidizing agent with a variety of uses depending on its concentration. Ingestion of hydrogen peroxide is not an uncommon source of poisoning, and results in morbidity through three main mechanisms: direct caustic injury, oxygen gas formation and lipid peroxidation. A case of a 39-year-old man who inadvertently ingested 250 mL of unlabelled 35% hydrogen peroxide intended for natural health use is presented. Hydrogen peroxide has purported benefits ranging from HIV treatment to cancer treatment. Its use in the natural health industry represents an emerging source for accidental poisonings.
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Salzman M, O'Malley RN. Updates on the Evaluation and Management of Caustic Exposures. Emerg Med Clin North Am 2007; 25:459-76; abstract x. [PMID: 17482028 DOI: 10.1016/j.emc.2007.02.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In 2004, the American Association of Poison Control Centers' Toxic Exposure Surveillance System documented over 200,000 exposures to caustic substances, in both household and industrial products. Although the most commonly affected body areas are the face, eyes, and extremities, all reported fatalities were as a result of ingestion. Little controversy exists in patient management following dermal or ocular caustic exposure. Immediate water irrigation of the site of caustic exposure, followed by routine burn care, analgesia, intravenous fluids, and electrolyte replacement are standards of care. In this manuscript, a thorough review of the management of gastrointestinal caustic exposure is explored, not only because of the high rates of morbidity and mortality associated with these exposures, but also because there remains controversy regarding appropriate management of such exposures. Hydrofluoric acid, a weak acid in its aqueous form, requires special consideration and specific antidotes, and as such, is addressed separately.
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Affiliation(s)
- Matthew Salzman
- Department of Emergency Medicine, Albert Einstein Medical Center, Korman Building B-6, Philadelphia, PA 19141-3098, USA.
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Kar H, Batuk G, Cekin N, Isler HB, Uzun I, Arslan MM. Deaths due to corrosive ingestion: a 10-year retrospective study. Toxicol Mech Methods 2006; 16:405-9. [PMID: 20021014 DOI: 10.1080/15376510600860490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Evaluation of the substances used, macroscopic and microscopic autopsy findings, and the manner of corrosive ingestion deaths in Istanbul are aimed in this study. METHODS The autopsy records of the corrosive ingestion cases in Istanbul, Turkey, between 1992 and 2001 are investigated in our retrospective descriptive study. RESULTS The cause of death was determined as "corrosive injury" in 23 (0.089%) cases among 25,763 autopsy cases. Among these cases one was in the child age group and the corrosive substance ingestion was accidental, whereas all the other cases were adults and the ingestion was for suicidal intent. Sixteen (69.6%) of the cases were female. Nitric acid was the most frequent agent with 13 cases (56.5%). Necrosis of esophagus was determined in 19 cases (82.6%) and perforation of stomach in 11 cases (47.8%). CONCLUSION Guidance and education are important tools for prevention from corrosive injuries, but we believe that the best weapon is to restrict easy access to corrosive agents by prohibiting the free commercialization of these most potent agents.
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Affiliation(s)
- Hakan Kar
- Specialist in Forensic Medicine, Council of Forensic Medicine, Adana Group Administration, Adana, Turkey
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