Overview of caustic ingestion cases at theChildren's Hospital of Vilnius University Hospital Santaros klinikos between 2011 and 2018.

Airida Narkutė,Virginija Žilinskaitė

doi:10.6001/actamedica.v26i4.4204

Abstract

Although not common, caustic ingestion can cause serious injury and sequelae. Clinical symptoms do not always represent thedepth of lesions of theintestinal tract, which makes management of these patients difficult. Between 2011 and 2018, we performed aretrospective one-centre study on ingestion of corrosive agents by children. We used ICD-10 codes of X49, X54.X, and T28.2. Cases of eye or skin burns were excluded. Sixty-five cases were found. Due to alack of data, we analysed 56 cases. Themajority of them were boys (64%); 41% of patients were between 12 and 24 months old. Themedian age was one year. In 68% of cases, thecorrosive substance was alkali: laundry detergent pods and sodium hydroxide accounting for 25% and 14%, respectively. Of the hospitalised patients and all those admitted to thepaediatric intensive care unit (PICU), 78% had oesophagogastroduodenoscopy (EGD), 61% within 24 h after ingestion. The time of EGD was not known for 29% of patients. Nine (29%) had 2nd- or 3rd-degree burns of theoesophagus or the stomach, one of them did not have any visible changes of thelips and oral mucosa or any symptoms. Physicians should be suspicious about potential lesions of thegastrointestinal tract when managing caustic ingestion cases. It is recommended to perform EGD for symptomatic children within 24 hours after theaccident.

Highlights

Ingestion of corrosive agents by children is uncommon, but this condition requires high suspicion (1)
In 68% of cases, the corrosive substance was alkali: laundry detergent pods and sodium hydroxide accounting for 25% and 14%, respectively
Of the hospitalised patients and all those admitted to the paediatric intensive care unit (PICU), 78% had oesophagogastroduodenoscopy (EGD), 61% within 24 h after ingestion

Summary

Introduction

Ingestion of corrosive agents by children is uncommon, but this condition requires high suspicion (1). Due to the discrepancy between the clinical picture and endoscopic findings, clinicians face difficulties in making decisions about further investigations and management (1). Caustic substances are divided into alkalis and acids (2), but some authors separate potassium permanganate and ammonia (1) as specific individual agents. Ingestion of alkalis is known to cause liquefactive necrosis and deep injuries across all parts of the gastrointestinal tract (1–3). Acids cause coagulative necrosis with the stomach affected more than other parts (1–3). Solid forms of corrosives, such as potassium permanganate, can cause serious local injury as they get attached to the mucosa. Caustic ingestion can cause serious injury and sequelae. Clinical symptoms do not always represent the depth of lesions of the intestinal tract, which makes management of these patients difficult

Methods

Results

Discussion

Conclusion