Caustic Ingestion In Children Research Articles

Results of emergency management of esophageal lesions related to caustic ingestion in children in the emergency department of the General Reference Hospital of Niamey (Niger)

Caustic ingestion in children is a public health problem; it is mainly due to domestic accidents due to improper packaging and storage of caustic products. It is a medical and surgical emergency whose management is multidisciplinary. The lesions caused by the accidental ingestion of caustics can affect the functional and vital prognosis in 10% of cases. A retrospective, descriptive study from January 2020 to December 2022 (2 years), carried out in the emergency department of the General Reference Hospital of Niamey (Niger). The study included patients less than 15 years old admitted for ingesting a caustic product. Our study included 17 patients. The average age was 5 years, with age extremes of 2 to 11 years. We noted a male predominance with a sex ratio (M/F) of 2.4. Ingestion of caustic products was accidental in all cases. The caustic product was caustic soda in 59%. The average quantity of product ingested was 5 ml (2 ml to 20 ml). The average consultation time was 3 days (3 hours to 15 days). Clinically, dysphagia was the most functional sign, represented by 13 cases, or 76%. Regarding general signs, 3 patients (18%) were admitted with fever; blood pressure was normal in 15 patients (88%); and 2 patients (18%) were admitted in a state of shock. The respiratory rate was normal in 14 patients (82%). Four patients (24%) were admitted in a state of deterioration in the general condition associated with severe malnutrition and dehydration. On physical examination, 2 patients (12%) presented with abdominal defense at the epigastric level. Examination of the ENT sphere revealed benign buccopharyngeal ulcerations in 2 patients (12%). Esogastroduodenal fibroscopy was performed in 4 patients (24%). The caustic lesions observed in the esophagus were: Zargar stage I at 25%, stage Ila at 50%, and stage Illb at 25%. In the stomach, the lesions were Zargar stage I in 75% of cases and stage III in 25% of cases. An injected thoracic-abdominopelvic computed tomography (CT) was performed in 3 patients (18%). It revealed a lack of enhancement of the esophageal wall compatible with esophageal necrosis in one patient. An esophagogastroduodenal transit was performed in 8 patients (47%) admitted more than 72 hours after ingestion of the caustic. They showed esophageal stenoses longer than 3 cm in 3 patients, multiple esophageal stenoses in 2 patients, a single esophageal stenosis in 2 patients, and a single antropyloric stenosis in 1 patient. Therapeutically, all patients benefited from antiemetics to avoid vomiting and proton pump inhibitors. Intravenous antibiotic prophylaxis with third-generation cephalosporin was administered to 12 patients (71%). Corticosteroid therapy based on IV prednisolone at a dose of 1 g/1.73 m2 per day was used to limit or prevent stenoses in 9 patients (53%). Parenteral nutrition was administered to 7 patients (41%). Endoscopic dilations were performed in 2 patients (12%). Emergency surgical treatment was performed in 7 patients (41%): 3 patients underwent transitional feeding gastrostomies; in 3 others, esophagoplasties by colon transplant were performed, and 1 patient was treated by stripping of the esophagus associated with total gastrectomy. The postoperative course was marked by a leak of esocolic anastomosis in one patient for whom conservative treatment was performed with good progress. The average length of hospital stay was 5 days (1-32 days). Accidental caustic ingestions can have serious consequences. Preventing these accidents relies on raising public awareness of the dangers associated with improper storage of these products.

Clinical aspects and endoscopic findings of caustic ingestions in children in Dakar, Senegal

Introduction: Caustic ingestion is a rare event, most often accidental in children, which can lead to lesions of varying severity in the digestive tract. The aim of this study was to describe the clinical aspects and endoscopic findings of caustic ingestions. Methods: This is a retrospective, descriptive, and analytical bicentric study carried out at the Albert Royer Children’s Hospital and the Dalal Jamm Hospital in Dakar. Children who had ingested a caustic product and undergone upper gastrointestinal endoscopy during the period May 1, 2020, to July 31, 2023, were included. Lesions were classified according to the Zargar classification. Results: A total of 35 children (23 boys; 65.7%) were included. The mean age was 25,1 ± 19,03 months, with a predominance of the 12-23 months age group (53.13%). Bleach (55.88%) was the most ingested caustic, followed by soda (26.47%). Oral erythema (29%) and erosions (22.5%) were the main physical signs; most often in the case of soda ingestion (90%; p = 0.004). Esogastroduodenal endoscopy showed lesions in 37,14% of children classified as stage I (17,14%), stage IIa (14.29%), and stage III (5.71%). The presence of labial or oral lesions was not significantly associated with the occurrence of digestive lesions (p = 0.37). Conclusion: Caustic ingestion is an accidental event in children. Bleach was the most ingested caustic. Caustic lesions of the digestive tract were dominated by erythema and ulceration.

Inadvertent caustic ingestion in children in a tertiary health facility in Enugu: critical review of three cases and current literature

Inadvertent ingestion of corrosive substances occurs frequently in children, especially in the younger age group. This could be attributed to their immaturity and the developmental stage of motor and sensory skills. The most common corrosive agent in our environment is caustic soda, which is used in soap making. This substance is usually stored in unlabelled containers without childproof safety caps. Adequate health education and effective legislation on the production, handling, and storage of corrosive substances will help mitigate the dangers of accidental ingestion in children. We present a report of three cases of unintentional caustic ingestion among children seen in Enugu and discuss the relevant literature.

Procedural and Surgical Interventions for Esophageal Stricture Secondary to Caustic Ingestion in Children

BackgroundEsophageal injury after caustic ingestion can vary in severity and may result in significant long-term morbidity due to stricture development. The optimal management remains unknown. We aim to determine the incidence of esophageal stricture due to caustic ingestion and quantify current procedural and operative management strategies. MethodsThe Pediatric Health Information System (PHIS) was utilized to identify patients 0–18 years old who experienced caustic ingestion from January 2007–September 2015 and developed subsequent esophageal stricture until December 2021. Post-injury procedural and operative management was identified utilizing ICD-9/10 procedure codes for esophagogastroduodenoscopy (EGD), esophageal dilation, gastrostomy tube placement, fundoplication, tracheostomy, and major esophageal surgery. Results1,588 patients from 40 hospitals experienced caustic ingestion of which 56.6% were male, 32.5% non-Hispanic White, and the median age at time of injury was 2.2 years (IQR: 1.4,4.8). Median length of initial admission was 1.0 day (IQR: 1.0, 3.0). 171/1,588 (10.8%) developed esophageal stricture. Among those who developed stricture, 144 (84.2%) underwent at least 1 additional EGD, 138 (80.7%) underwent dilation, 70 (40.9%) underwent gastrostomy tube, 6 (3.5%) underwent fundoplication, 10 (5.8%) underwent tracheostomy, and 40 (23.4%) underwent major esophageal surgery. Patients underwent a median of 9 dilations (IQR 3, 20). Major surgery was performed at a median of 208 (IQR: 74, 480) days after caustic ingestion. ConclusionMany patients with esophageal stricture after caustic ingestion will require multiple procedural interventions and potentially major surgery. These patients may benefit from early multi-disciplinary care coordination and the development of a best-practice treatment algorithm. Level of evidenceIII.

Caustic oesophageal stricture treated by instrumental dilatation: A review of 6 years of practice at the pediatric university hospital charles de gaulle of Ouagadougou.

Oesophageal stricture is one of the most important and redoubtable complications following caustic ingestions in children. Instrumental dilatation is usually considered the first line of treatment. This study aims to evaluate the outcomes of caustic stenosis treatment when using Lerut dilatators. This is a descriptive retrospective study from May 2014 to April 2020. All children under 15 years hospitalised in our department for caustic oesophageal stricture and had a gastrostomy and oesophageal dilatation with insertion of an endless wire were included. A total of 83 patients were included. The sex ratio was 2.2. The mean age was 4 years. The mean time from caustic ingestion to presentation was 90 days. Oesophageal stricture was mostly caused by caustic soda (n = 41) and potash (n = 15). We performed in total 469 dilatations and had only three oesophageal perforations. After a mean follow-up of 17 months, we had 60.2% good results (n = 50) and 7.2% (n = 6) failures. The mortality rate was 13.2% (n = 11). The results of the dilations by Lerut dilatators give encouraging results in our department. It is easy to perform and its complications remain rare. Mortality could be reduced by adequate nutritional support.

Caustic Ingestion in Children: The Otolaryngologist Perspective.

Caustic ingestion in children is a significant cause of morbidity despite preventive measures. Upon arrival to the emergency department, these children are often initially seen by the otolaryngologist and later on by the gastroenterologist. This study aimed to determine which otolaryngological and gastrointestinal signs and symptoms can better predict abnormal findings on imaging, esophagogastroduodenoscopy (EGD), and complications development. We performed a retrospective chart review of children 18 years or younger admitted because of caustic ingestion between January 2007 and November 2019. Forty-one children with a median age of 4.2 years (interquartile range, 1.7-16.7 years) were included; of them, 22 (53.6%) were males. Nineteen children (46.3%) underwent EGD, which revealed no pathology in 13 cases (68.4%). Most ingested substances were in the form of liquid (82.9%), accidentally ingested (82.9%), and with an alkaline pH (57.5%). Stridor, dyspnea, drooling, abnormal oral cavity findings, dysphagia, and vomiting were significantly associated with pathological findings on imaging and/or EGD and/or complications development ( P = 0.028, P = 0.028, P = 0.022, P = 0.02, P < 0.001, and P = 0.01 respectively). Laryngopharyngeal group of findings (dyspnea, stridor, hoarseness, sore throat, and/or drooling) predicted a higher risk for complications development than the gastrointestinal group (dysphagia, abdominal pain, vomiting, or abdominal swelling and/or tenderness) ( P = 0.011, P = 0.31 respectively). In children, after caustics ingestion, laryngopharyngeal signs and symptoms may predict a higher risk for complications development in comparison with gastrointestinal signs and symptoms. We therefore stress the importance of otolaryngological examination upon arrival to the emergency department.

Caustic ingestion in children treated at a tertiary centre in South Africa: can upper endoscopy be omitted in asymptomatic patients?

Considering that clinical presentation and gastrointestinal tract (GIT) injuries post-caustic ingestion vary in children, this study aims to establish whether a correlation exists between clinical presentation and endoscopic findings. This retrospective study comprised patients referred to a paediatric surgical unit between 2016 and 2018 within 72h post-caustic ingestion. Data collected included caustic agents ingested, clinical presentation, endoscopic findings and management. Oesophageal injuries were graded according to the Zargar's endoscopic classification and gastric injuries classified as mild to severe. Fifty patients with a mean age of 2.4years were managed during the study period. Potassium permanganate (KMNO4) was the most frequently ingested substance in 27 (54%) patients. All 30 (60%) asymptomatic patients had no positive endoscopic findings regardless of clinical signs. Among the symptomatic patients (n = 20), 15 (75%) had oesophageal injuries (p = 0.01). Stridor was associated with a higher grade of oesophageal injury (p = 0.007). Clinical signs and symptoms post-caustic ingestion correlated with endoscopic findings in our study. Endoscopy can be safely omitted in asymptomatic patients, including those with isolated staining secondary to KMNO4 ingestion. Symptomatic patients should have an endoscopy performed within 48-72h of the insult to diagnose injuries.

Caustic ingestion in children: A 6-year retrospective study

Some aspects of the management of caustic ingestion in children are still debated. We aimed to determine the predictive value of epidemiological and clinical features of caustic ingestion, and to define guidelines adherence. This is a retrospective study on children ≤18 years referred to our Emergency Department over 6 years because of caustic ingestion. Statistical significance at p&lt;0.05. Overall, 107 caustic ingestions were identified, mainly accidental &lt;5 years (87.85%). Bleach was the most common caustic (46.73%). Forty-six patients underwent endoscopy; 57.38% children who should have endoscopy on guidelines, actually did not (p&lt;0.0001), but no complications were reported. No or minimal lesions were reported in asymptomatic children; ≥2 symptoms correlated with the severity of lesions (p&lt;0.0002). Therapy of severe cases was correct; overtreatment was observed for minor injuries (p&lt;0.0001). Asymptomatic children after caustic ingestion have a very low-probability of moderate-severe endoscopic lesions, and the risk of severe damage increases proportionally with ≥2 symptoms. Prospective studies are needed to evaluate the efficacy of intensive clinical observation versus EGD on low-risk children to identify those with clinically relevant esophageal lesions.

Successful Esophageal Replacement Surgery in a 3-Year Old with Post-corrosive Esophageal Stricture

Accidental caustic ingestion in children, though entirely preventable, continues to be present in developing countries. Gastrointestinal injuries following caustic ingestion in children range from mild to fatal. Presentation of such children to the medical facility could be early or sometimes late with complications. Management is based on the type of injury and could range from medical conservative management to complex surgical procedures. Such complex surgeries are almost unavailable in developing countries. We present a 3-year old who presented to our facility with an esophageal stricture following accidental caustic ingestion four months prior to presentation. He had a failed stricture dilatation and needed to be managed surgically; he subsequently had a good outcome, which is rare in developing countries.&#x0D; Keywords: Post-corrosive esophageal stricture, Esophageal replacement surgery

A 10-year analysis of the characteristic of pediatric caustic ingestions at Royal Hospital in Oman

Background: Caustic ingestions in children are preventable exposures that can lead to severe morbidity and mortality. The current international guidelines recommend performing esophagogastroduodenoscopy (EGD) within 12 to 24 hours post ingestion. In addition, these recommendations suggest that grade II lesions on EGD and above should receive antibiotics and steroids.

Caustic Ingestion in Children: 1 Year Experience in 3 Italian Referral Centers.

Despite the efforts to reduce the exposure to corrosive household products, caustic ingestion in children is currently a significant medical problem. The aims of the present study were to evaluate the clinical consequences of caustic ingestion and to identify prognostic factors that could concur in driving both diagnostic and therapeutic management. All consecutive children referred for ingestion of a caustic substance from June 2017 to June 2018 were enrolled. Medical records, laboratory and endoscopic findings were reviewed and analyzed. We enrolled 44 children with caustic ingestion. Alkaline agents were ingested by 26 of 44 (59.1%) patients, whereas acid agents were ingested by 18 of 44 patients (40.9%). Alkaline rather than acid agents were associated with a worse endoscopic score (r: 0.45) and a higher probability of early esophageal stricture occurrence (r: 0.38). The specific risk of the presence of severe esophageal lesions rose progressively with increasing number of symptoms whereas no esophageal injury was found in asymptomatic patients. Our data suggest that endoscopic evaluation is mandatory in symptomatic patients to direct therapeutic management, but it could be avoided in asymptomatic patients after accidental ingestion, particularly if the ingestion is only suspected and patients have no oropharyngeal burns.

The role of endoscopy in caustic ingestion in the pediatric population: experience in a tertiary center.

caustic ingestion in children is rare but has potentially serious consequences. to analyze the clinical and endoscopic features and the type of caustic ingested in our population. the upper endoscopies performed in this setting, as well as the characteristics of patients and caustics, were analyzed from 2010 to 2018. fifty-one endoscopies were performed (48 cases of witnessed intake or high suspicion and three with a low suspicion) in patients with a mean age of 2.55 years. Alkali ingestion was more frequent (88.2 %) and 56.9 % of the endoscopies were normal, which was more frequent among those who ingested bleach (72 %). Alkali tended to produce more esophageal injuries (31.1 %) and acids tended to produce esophageal (20 %) and esophageal-gastric injuries (20 %). Four patients developed esophageal stenosis during follow-up. even though more than half of the studies were normal, endoscopy is important in the diagnosis and prognosis of these patients.

Endoscopic findings of the digestive tract secondary to caustic ingestion in children seen at the Emergency Department.

Caustic ingestion in pediatrics is a common cause of visits to the Emergency Department. An indiscriminate use of cleaning chemicals and an easy access to them are determining factors for these injuries. Descriptive, analytical study. Children aged < 16 years hospitalized between January 1998 and December 2017 were included. The ingested caustic substance was identified as acid or alkaline. A gastrointestinal endoscopy was done to establish the burn grade. The grade of the burn was compared to the type of caustic substance using the χ2 test or the Fisher's exact test; a P value < 0.05 was considered significant. A total of 133 children were admitted to the Emergency Department due to caustic ingestion. The caustic agent was acid in 41 % of cases and alkaline, in 59 %. The most common acid caustic substance was muriatic acid (36.8 %) and the most common alkaline caustic agent was caustic soda (41.4 %). An esophageal burn was the most common consequence of caustic soda ingestion compared to other caustic agents (p = 0.001), whereas muriatic acid ingestion was the most statistically significant cause of stomach burn (p = 0.001) and duodenal burn (p = 0.002). The age group that most commonly ingested some caustic agent (93.2 %) corresponded to children younger than 5 years. The most common type of ingested caustic agent was alkaline, which caused esophageal burn; whereas, the ingestion of an acid caustic substance caused stomach and duodenal burns, as evidenced by endoscopy.

Prospective study of the effect of topical application of Mitomycin C in refractory pediatric caustic esophageal strictures.

Esophageal strictures resulting from caustic ingestion in children are usually difficult to be managed, and surgical replacement is usually required for cases refractory to frequent dilatation sessions. Topical Mitomycin C (MMC) has been recently used in the management of resistant strictures. We evaluated the efficacy of MMC application in treatment of long refractory caustic esophageal strictures. This prospective study included 120 patients of both sexes with refractory caustic long esophageal strictures (> 3cm in length). All patients were randomly divided into two equal groups using the research randomizer program (1:1 randomization), group I underwent endoscopic dilatation therapy only and group II underwent dilatation with topical application of MMC. Follow-up was done regularly by assessing the dysphagia score and patients were evaluated after 6 months of management. The procedure was repeated four times with 2-week intervals. Complete relieve of symptoms (dysphagia score = 0) was assessed after the follow-up period. The complete cure was detected in 81.6% of patients in the MMC group compared to only 40% in the first group, p-value < 0.0001. During the follow-up, the average sessions of dilatation needed in group II were 3.25 ± 2.78 compared to 6.25 ± 1.74 sessions in group I (p < 0.001). The mean cost of sessions in patients who showed symptomatic and endoscopic improvement was significantly lower in group II (272.2 ± 51 US$) when compared to group I (404 ± SD 55.7 US$). Cure rate was double in the MMC group. MMC application significantly improved symptoms and reduced both the number and frequency of dilatations to alleviate dysphagia in patients with refractory caustic esophageal strictures and hence reduced the cost of treatment.

Surgical treatment of massive bleeding of a right aberrant subclavian artery after oesophageal stent removal

Abstract We report a case of a 9-year-old female who required surgical treatment and resuscitation after severe transoesophageal bleeding of a right aberrant subclavian artery (RASA). Bleeding of this RASA was caused by a mechanical irritation due to an oesophageal stent. The stent was placed weeks before to dilate the oesophagus after accidental ingestion of a caustic agent. Although conservative management of benign oesophageal stenosis in children is highly recommended, there are still some major complications to be considered. To avoid erosion of aberrant subclavian artery vascular rings and slings, as described in several case reports, these vessels should be excluded by computed tomography (CT) or magnetic resonance imaging (MRI) scans before placement of oesophageal stents. This case suggests that management of caustic ingestion in children is still a major challenge in paediatric surgical departments.

Concordance between Observers for the Diagnosis and Endoscopic Classification of Esophageal Lesions Due to Caustic Ingestion in Children

Introduction The accidental ingestion of caustic materials among children continues to be a public health problem, with an incidence in international reports of 15.8 / 100, 000 per year. In our environment, at the Fray Antonio Alcalde Civil Hospital, this incidence has an average of 2.5 cases per month, around 30 cases per year. Objective. To evaluate the agreement between observers for the diagnosis and endoscopic classification of esophageal lesions due to the ingestion of caustics in children. Material and methods. A historical cohort study was conducted in 2,190 days with patients diagnosed with esophageal stenosis secondary to caustic ingestion during a period between 2010 and 2016. Photographic records of patients who met the inclusion criteria were recovered. Diagnostic endoscopy at the time of caustic ingestion. These reports and the fixed images of the esophagus were classified according to Zagar’s Scoring Systems for Caustic Injuries. The following variables were collected: sex, age in months, date of ingestion of caustic substance, type of ingested caustic substance, presence of complications in the acute stage, degree of initial injury according to Zagar’s classification. We reviewed the results of the esophagogram and the diagnostic endoscopy at the time of caustic ingestion and the first revision endoscopy. Later these images were evaluated by the same endoscopist and by two others, the three reports were classified according to Cohen’s Kappa coefficient, to compare the agreement between endoscopists, as well as the Kappa coefficient of Feiss to compare the general concordance etre the three endoscopists, both coefficients with a confidence interval of 95% (Kappa +/- 1.96 standard error). Statistical analysis was performed through SPSS version 19. Results A total of 43 patients with diagnosis of caustic ingestion at the Civil Hospital of Guadalajara “Fray Antonio Alcalde” were reviewed. The characteristics of the patients in relation to sex, 13 (30%) were female and 30 (70%) of the male sex The average age was 34.5 months, with a range of 12 to 96 months. 42 patients for caustic soda (98%) and one patient with burn by muriatic acid (2%). First-time endoscopy was performed within the first 18-24 hrs after the injury, they did not present any complications in the acute stage, and they had the diagnosis of caustic burn according to the Scoring Systems for Caustic Lesions of Zagar. , identifying 2 patients with grade I burns (4.6%), 8 patients with grade IIa burn (18.6%), 14 patients with grade IIb burn (32.5%), 17 patients with burn IIIa (39.5%) and 2 patients with burn IIIb (4.6%). A total of 63 images were obtained, which were identified according to the predominant pattern of lesion due to caustic ingestion based on Zargar’s classification. Each image was displayed in a time of 20-30 seconds, with the total evaluation ending in an average of 30 minutes. The variability of concordance between pairs of endoscopists was compared when integrating the 3 endoscopists, a Kappa Feiss Coefficient of 0.3948 was obtained, with a standard error of 0.0402 and a confidence interval of 95% from 0.3160 to 0.4736. With this tool the kappa coefficient observed for the degree of esophageal burn injuries according to the Zargar Classification was 0.6585 (good concordance strength) for grade I, 0.4393 (moderate concordance force) for grade II a, 0.3000 (force low concordance) for grade II b, 0.4674 (moderate agreement strength) for grade III a, and 0.0950 (agreement strength without agreement) for grade III b. Discussion and conclusion The overall agreement (Kappa Feiss) regarding the decision of the presence / absence of mild / severe esophageal lesions (grade I, II a vs. grade II b, III a, III b) had a moderate reliability, but poor for leveling fine of each of the grades, with the strength of negligible agreement (kappa 30 0.0950) for grade IIIb, low (kappa 0.3000) for grade IIb, moderate for grade IIa (kappa 0.4393) and IIIa (kappa 0.4674) and good for grade I (kappa 0.6585). We believe that endoscopy is a mandatory and effective technique that should be performed to prevent unnecessary hospitalization and medication, as well as to plan initial treatment and to predict patients who are at risk of developing esophageal stenosis and / or obstruction of the exit gastric and can be performed without complications in expert hands.

Caustic Ingestions in Children

To discuss the new risks associated with caustic ingestion and increase awareness of the variation in clinical presentation, initial management, and long-term complications associated with ingestion of corrosives and button batteries. Improper storage of caustic materials continues to be a major risk for caustic ingestion. Symptomatic patients should undergo endoscopy for injury assessment and feeding tube placement. Corticosteroids may play a role in decreasing risk of stricture formation. Pod detergents are commonly ingested and need to be properly child proofed. There is a higher risk of morbidity and mortality associated with ingestion of larger lithium button batteries. Esophageal and gastric strictures are common and may require dilatation, esophageal stents, incisional therapy, and surgery. Improved education is needed to decrease the sequelae caused by ingestion of caustic substance and button batteries.

Caustic Ingestion in Children in South of Iran: A Two-Year Single Center Study.

BACKGROUND Caustic ingestion is one of the most important injuries during childhood, which leads to serious sequel. In this study, we evaluated the clinical manifestations, endoscopic appearance, complications, and treatment results in patients with caustic ingestion in our hospital. METHODS Hospital chart of patients with caustic ingestion who admitted to Nemazee Teaching Hospital affiliated to Shiraz University of Medical Sciences during a 2-year period (2015-2016) were reviewed retrospectively. The age, sex, nature of the caustic agent, clinical presentations, grade of injury in endoscopy, degree of parents’ education, site of ingestion, accidental or intentional attempts, complications, and outcomes were reviewed. RESULTS In this study the charts of 41 patients (26 boys and 15 girls) with caustic ingestion over the 2-year period were reviewed. The mean age of the patients was 4.4 year. Of them, 95.1% had ingested the materials accidentally, and 2 (4.9%) patients had ingested unknown substances for suicidal attempt. Of all cases, 68.3% of caustic ingestion occurred in the kitchen. 19 (46.3%) agents were acidic substances and 17 (41.5%) were alkali agents. 5 (12.1%) patients ingested unknown substances. 24.3% of the patients were asymptomatic and the most common presentation was drooling (34.14%). 26.8% of the patients had dysphagia, and 24.3% presented with oral ulcer. 7.3% had abdominal pain, 4.8% had fever, and 2.4% had hematemesis. 14 (34.1%) patients had normal feature, 6 (14.6%) had grade I injury, 12 (29.3%) had grade II injury, and 8 (19.5%) had grade III injury in endoscopic evaluation. CONCLUSION Most of the caustic ingestion occurred in kitchen. Male was the dominant sex in the caustic injury.

Caustic ingestion in children—A review

Various domestic or industrial chemicals may cause significant upper aerodigestive tract burns. Preventive measures should be up-scaled, especially in the developing world, to reduce the epidemic of accidental victims, largely unsupervised preschool children. External signs do not predict degree of injury. Non-invasive diagnostic screening includes radio-nuclear imaging, but early oesophago-gastroduodenoscopy remains the standard to predict stricture formation from circumferential submucosal scarring. Serial dilation is the mainstay of oesophageal stricture therapy, with oesophageal replacement reserved for severe refractory strictures. Intra-lesional steroid or mitomycin C may decrease the dilatations required for severe strictures, although long-term effects are unknown. Risk of secondary oesophageal carcinoma mandates long-term surveillance.

Caustic Ingestion in Children: a Systematic Review and Meta-Analysis.

Introduction:Caustic ingestion that occurs accidently is one of the most common problems in children. Methods: This systematic review has been performed by searching the databases including Science Direct, ProQuest, Google Scholar, and PubMed. A strategic search was performed with keywords including caustic, corrosive, ingestion, and children, and was limited to articles in English and Persian. Data were analyzed using Comprehensive Meta-Analysis2 and PASW Statistics 18. Results: We selected 64 articles regarding caustic ingestion with a total sample of 11,345 cases. The data analysis indicated a higher consumption in young boys (age range 2.78 (2.02) years (OR=0.53 with a 95% confidence interval of 0.49-0.57 (P=0.08)). The most common caustic substances were household cleaning agents, particularly bleaches and cleaners. Esophageal cancer and death were reported as well as digestive and respiratory complications. Invasive and expensive techniques are frequently used for diagnosis, treatment and follow up. Conclusion: The results demonstrated that although caustic ingestion is a serious problem among children, it is a preventable and manageable issue. Therefore, appropriate efforts by families, government, factories, health team and media should be made to handle adequately this matter.