Cases Of Caustic Ingestion Research Articles

S3141 Severe Non-Hemorrhagic Esophageal Endoscopic Urgencies: Clinical Outcome and Predicting Factors

INTRODUCTION: Caustic and foreign body ingestion represent a significant part of endoscopic urgencies and can lead to critical condition. A correct use and interpretation of diagnostic findings at admission is mandatory for risk stratification and subsequent clinical decision. METHODS: Retrospectively evaluate hemorrhagic urgencies, especially Foreign body ingestion (FBI) and caustic ingestion (CAI) admitted in our center between 2000 and 2019. RESULTS: Sixty-seven patients were included (M/F: 1.79, mean age 54.3 ± 13.3 years): 44 cases of FBI (most frequently animal bones) and 23 cases of CAI (most commonly Sodium Hypochlorite). The Charlson Comorbidity score index had a mean value of 3, with no significant difference between FBI and CAI groups. Psychiatric disease, namely alcoholism and depression affected 27 patients (40%) and was strongly associated with CAI and intentional ingestion (P < 0.0001). Among all patients, 66 had a mean length of hospitalization (LoH) of 15 days (CAI vs FBI, 24.9 vs 11.3 days, P 0.05). Blood tests at first day showed a mean value of C-reactive protein (CRP) of 68.9 mg/L in FBI group and 27.2mg/L in CAI group with a significant difference (P = 0.036) and significantly associated with LoH in the FBI group (P > 0.001), but not in CAI group. WBC had a mean value of 10.3 × 10^9/L in FBI and 11.3 × 10^9/L with no significant differences between FBI and CAI (P 0.28) and no significant association with LoH (P 0.37). EGDS was performed in most cases within the first 24 h. In the CAI group, esophageal involvement was complete in the 65% of the cases. Zargar classification showed a significant association with LoH in CAI group (P 0.042). In the FBI group, lacerations were recognized in 41.5% of the cases, while perforation was present in 29.3%, with no significant association with outcome. Among the findings of CT scan, edema of the esophageal wall was the most common finding in CAI group (P 0.02) and perforation in FBI group (P 0.006). In the CAI group, CT scan Severity Index was significantly associated with LoH (P 0.01), while the presence of perforation was the most significant factor in the FBI group (P 0.06).Table 1CONCLUSION: EGDS with Zargar Classification is useful for risk stratification in patients with caustic ingestion. CT scan Severity Index for caustics and the presence of perforation for foreign body ingestion are associated with severity of the condition. CRP at admission is an excellent and inexpensive predictor of clinical outcome in foreign ingestion cases.

A183 UPPER GASTROINTESTINAL CAUSTIC INJURIES: A SINGLE CENTRE CASE SERIES

Abstract Background Caustic esophageal and gastric injury is a rare, but potentially lethal event. The 2017 American Association of Poison Control reported only 193,000 cases of caustic ingestion (1). Caustic agents are acidic or alkaline. The pH of the ingested substance dictates the type of injury and the area of the gastrointestinal track most at risk. The most common culprit agents are alkaline including, for example, bleaches, drain openers and dishwashing detergents. Due to the rarity and natural history of this disease there are very few high-quality studies for clinicians to refer to when managing these patients. Aims We present three cases of caustic ingestion and provide a review of current best practice standards. Methods Between August and September 2019, three patients were admitted to Sunnybrook Health Sciences Centre at the University of Toronto for caustic injury. All three patients were referred to the gastroenterology service and underwent an esophagogastroduodenoscopy (EGD) to assess the degree of esophageal and gastric injury. Patients were followed both in hospital and in the outpatient setting for ongoing surveillance and repeated endoscopic evaluation. Patient demographics, treatment, endoscopic findings and outcomes were collected. Results Three patients intentionally ingested caustic agents, were admitted to hospital and managed by the gastroenterology service. Patients were a mix of ages, genders and ethnicities. All ingestions were strong alkali agents including sodium hydroxide and sodium hypochlorite. All patients underwent an EGD within 24 hours of presentation and caustic injury was graded using the Zargar classification (2). All patients were started on intravenous proton pump inhibitor therapy. All patients were initially made nothing per mouth and ability to resume feeds was assessed based on symptoms. Patient 1, Zargar grade 1, was able to resume oral intake within 48 hours and progressed to a regular diet without complications. Patient 2, Zargar grade 2a, required 5 days of TPN and bowel rest after which a liquid diet was initiated and advanced without complications. The third patient, had a severe injury (Zargar grade 3b), requiring a prolonged hospital stay. He was on TPN for three weeks before transitioned to tube feeds. Conclusions Caustic mucosal injuries are an infrequent, but potentially lethal event requiring urgent assessment and management by a team including gastroenterologists, thoracic and abdominal surgeons, dieticians and intensivists. High-quality evidence to guide management of caustic injuries remains limited. In our case series, there was a wide spectrum of degree of mucosal injury. All 3 patients were managed in a consistent fashion based on current recommendations. Two of three cases had a rapid recovery with the ability to resume oral intake and return home. The third patient remains in hospital, requiring a high level of supportive care. Funding Agencies None

Caustic Burns in Adults: Epidemiological, Clinical, Endoscopic and Evolutionary Aspects at Sourô Sanou University Hospital Center in Bobo-Dioulasso

The ingestion of a caustic product is a frequent and sometimes serious accident which can, in the acute phase, bring into play the vital and functional prognosis. The authors report the results of their experiments on 18 cases of caustic ingestion. This was a retrospective descriptive study conducted from February 2012 to January 2016 in the Hepatogastroenterology department of Souro-Sanou University Hospital Centre of Bobo-Dioulasso, Bobo-Dioulasso. All patients over the age of 15 admitted for ingestion of caustics and having undergone upper gastrointestinal endoscopy were included. During the 48-months study period, 18 cases of caustic ingestion were recorded, of which 8 men were a sex ratio of 0.8. The average age was 31.25 ± 13.26 years. Ingestion of caustic was voluntary in 8 out of 10 cases. Ingested product was acidic in 66.67% of cases. The clinical picture was defined by hematemesis (50%) and oral lesions (38.89%). Endoscopic lesions were dominated by stage IIb (50%) of ZARGAR. The evolution was marked by a lethality of 11.11%. Caustic burns of the digestive tract are infrequent but serious in our context. Endoscopy plays a very important role in the diagnosis, but their management remains difficult.

Clinical Spectrum and Management of Caustic Ingestion: A Case Series Presenting Three Opposing Outcomes

Case seriesPatient: Fenale, 77 • Female, 46 • Female, 33Final Diagnosis: Caustic injurySymptoms: —Medication: —Clinical Procedure: SurgerySpecialty: SurgeryObjective:Unusual clinical courseBackground:Ingestion of caustic substances is a medical emergency in both the adult and pediatric population and is associated with high morbidity and mortality. The extent of injuries after ingestion of caustic substances depends on the nature, amount, and concentration of the agent and on the exposure time. Acutely, caustic substances may cause massive hemorrhage and gastrointestinal tract perforation; the most markedly affected cases require urgent surgical treatment. Patients surviving the initial event may present with aorto-enteric or gastrocolic fistulae, esophageal strictures, dysphagia, and increased risk of esophageal cancer as long term sequelae.Case Report:The features of three cases of caustic ingestion are reported to demonstrate significantly different complaints presented at the emergency department. Two patients had free gastric perforation, one at presentation, and one delayed. The third patient presented with late severe strictures of the esophagus and pylorus. The outcomes of the three patients are discussed in detail along with the most current management strategies.Conclusions:Among adults, ingestion of caustic substances is usually associated with more severe lesions due to the increased amount of ingested substance, as compared with pediatric patients. The most serious presentation is that of visceral perforation, most commonly of the stomach and rarely of the esophagus. Management involves urgent resuscitation with correction of fluid and electrolyte and acid-base abnormalities and immediate surgical exploration in those patients with signs of perforation. Once the perioperative period is managed successfully, the long-term results can be satisfactory. Managing of strictures or else reconstructive procedures must be well timed to allow for psychological and nutritional rehabilitation.

Respiratory and gastrointestinal complications of caustic ingestion in children

Objectives: To determine circumstances surrounding the ingestion of caustic substances, the incidence of respiratory and gastrointestinal symptoms at presentation, and the degree of investigation and active treatment during hospitalisation. Long...

Hair Relaxer Ingestion: A New Trend

Although the health care system has done much to reduce the incidence of ingestion of such alkalis as drain and oven cleaners, in recent years we have seen an overwhelming increase in the incidence of hair relaxer ingestion. In a 5-year review (1987 to 1992) of 48 cases of caustic ingestion, 15 cases involved alkaline hair-relaxing agents. This retrospective study was undertaken to evaluate the agents ingested, the presenting signs and symptoms, the diagnostic procedures, and the outcomes in those 15 cases. Oral cavity and lip burns were common in these children, but none of the 15 had significant esophageal burns. Education of the medical and lay community about the risk of hair relaxer ingestion should be undertaken to reverse this worrisome trend.