Chapters authored
Caustic Ingestion in Children
Caustic ingestion (CI) is an unfortunate event that occurs in families with a poor prevention culture. Its prevalence is unknown in developing countries; it occurs mainly in children < 5 years and is more common in boys. The chemical caustic agents are alkaline (85%) or acid products stored in food or beverage containers without warning labels and safety caps. The immediate symptoms include salivation, oropharyngeal burns, vomiting and oropharyngeal/retrosternal pain. Upper endoscopy is the first‐line tool to identify the type and extension of oesophageal and gastric damage. A barium swallow performed 2–3 weeks after the CI may identify oesophageal stricture. Dysphagia occurs in about one‐third of cases. Regarding the nutritional status, children with dysphagia and/or oesophageal strictures may have lower fat reserves or muscle mass than the cases without these complications, meaning impaired nutritional status. All patients should be hospitalized for evaluation and treatment. Hemodynamic stabilization and adequacy of the patient’s airway are priorities; vomiting induction and gastric lavage are contraindicated. Methylprednisolone in II-b oesophageal burns for 3 days diminishes the risk of stricture. Selected cases will require oesophageal dilatations, gastrostomy or oesophageal replacement by colon or stomach. There are other promising agents in the management of caustic oesophageal strictures.
Part of the book: Esophageal Abnormalities