Ingestion Of Caustic Agents Research Articles

Minimally invasive repair of a late stricture in a reversed gastric tube

Ingestion of caustic agents may result in severe scarring and stricture formation of the esophagus. Reversed gastric tube esophagoplasty is an option for definitive surgical management of severe esophageal stricture refractory to medical treatment. Delayed complications from this procedure have rarely been reported. We present a case involving a patient who developed a delayed gastric stricture three decades after receiving a reversed gastric tube esophagoplasty. A historical review of the reversed gastroplasty is presented as well.

Endoscopic Characterization of Caustic Ingestion in Zambia

Purpose: Ingestion of caustic agents can cause severe upper gastrointestinal damage. Data from developing nations is deficient due to under-reporting and lack of or late presentation to healthcare providers. AIM: To describe endoscopic findings of caustic ingestion. Methods: We conducted a retrospective cohort study, at University Teaching Hospital (UTH), a tertiary medical center in Lusaka, Zambia. We reviewed endoscopy records from January 1999 to May 2010 and searched for any mention of caustic ingestion. Parameters examined included age at presentation, gender, nature of the caustic substance ingested (acid or alkali), accidental or intentional and anatomical distribution of injury in the gastrointestinal tract. Results: We identified 43 cases of caustic ingestion. The mean age was 24 years, ± 8.7, and predominantly male 39/43 (90%). The most common caustic agent ingested was acid (53%) followed by alkali (47%). Endoscopic findings included gastric outlet obstruction (55%), esophageal stricture (30%), gastric ulcer (21%), pyloric ulceration (16%), gastritis (14%), esophageal ulceration (9%) and duodenal ulceration (2%). There was no difference in the endoscopic findings between men and women. The type of injury sustained was also not related to the type of substance ingested (acid or alkali). Data regarding situation of ingestion (accidental or intentional) was not available on endoscopy reports. Conclusion: The most common endoscopic outcomes were gastric outlet obstruction and esophageal stricture. Early diagnosis of caustic ingestion is important to guide treatment and prevent complications. Funding should be allocated towards raising public awareness.

Isolated jejunal stricture formation two years after corrosive ingestion: Case report and review of literature

The ingestion of caustic agents is mostly accidental, especially in children. In adults, intentional, mainly suicidal cases of corrosive ingestion are frequently reported, which are more often fatal. Most corrosive ingestion is of cleaning substances, which mainly contain alkali substances. Since declaration rules for harmful substances have been restricted, the incidental ingestion of caustic substances has become rarer in the last years. However, the American Association of Poison Control Centres reported 216 228 poisonous human exposures to cleaning substances in 2007, which were mainly accidental.

A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child

A Biodegradable Esophageal Stent in the Treatment of a Corrosive Esophageal Stenosis in a Child

Caustic ingestion in adults: The role of endoscopic classification in predicting outcome

BackgroundThe 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.MethodsThe 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.ResultsA 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).ConclusionIn 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.

Aortoesophageal Fistula Due to Caustic Ingestion

Caustic agent ingestion may produce corrosive lesions that can extend beyond adjacent organs. We report three cases of aortoesophageal fistulas (AEF) after caustic ingestion that were diagnosed by autopsy. AEF is a fatal complication that should be suspected in any patient with caustic ingestion who presents with gastrointestinal bleeding. A high index of suspicion, early recognition by gastrointestinal endoscopy, computed tomography scan, and aortography are important to improve the outcome.

Increasing tendency in caustic esophageal burns and long-term polytetraflourethylene stenting in severe cases: 10 years experience

In recent years, lye products have come into common household use in Turkey. Unfortunately, we have noted more cases of serious corrosive esophagitis owing to accidental caustic agent ingestion. The aims of this study were to (1) evaluate our experience with these cases and (2) investigate the effects of long-term intraesophageal polytetraflourethylene stenting on esophageal remodeling and its impact upon the need for esophageal replacement. Between 1997 and 2006, 68 patients (44 males and 22 females) with accidental caustic agent ingestion were admitted to our department, the only tertiary care referral center for the Turkish Army. Once stabilized, esophagoscopy was performed for injury grading (grades 0, 1, 2a, 3b, 3a, or 3b) as described by Millar and Cywes ( Pediatric surgery. 1998;969-979). Esophagogram was performed 3 weeks after injury to assess healing. At presentation, the injury grade for 24, 31, 11, and 1 cases were 0 or 1, 2a, 2b, and 3a, respectively. One case had gastric outlet obstruction. All cases of grade 0 or 1 injuries had a normal esophagogram at 3 weeks postinjury. For the remaining 44 patients, several treatment modalities have been applied, including antegrade and retrograde dilatations in 31 grade 2a patients, intraluminal stenting in 11 grade 2b patients, esophageal reconstruction in 1 grade 3a patient, and gastroenterostomy in 1. Of the 11 patients with esophageal stenting, 8 patients have resumed a normal diet after 9 to 14 months of stenting. Mean follow up duration is 3.5 years (1-6 years) after stent removal. In the remaining 3 cases, treatment is still ongoing. Esophagitis and esophageal structuring because of caustic agent ingestion is a major public health problem in Turkey. Our small uncontrolled pilot series suggests that intraluminal polytetraflourethylene stenting may be an effective treatment method to reduce the need for major surgical reconstruction of recalcitrant esophageal strictures.

Esophageal injuries caused by accidental ingestion of caustic agents in children

Esophageal injuries caused by accidental ingestion of caustic agents in children

Ingestion of Caustic Substances: A 15‐Year Experience

The objective of this study was to analyze the circumstance, demographic features, clinical findings, and complications of caustic ingestion in relation to the type and amount of caustic substance. The authors conducted a retrospective cohort study in a tertiary medical center. The authors reviewed medical records from 1988 to 2003 of patients with a history of caustic ingestion and clinical signs of injury to the aerodigestive tract. Parameters examined included age at presentation, gender, demographic status, nature of the caustic substance ingested, amount of substance, circumstance of the event, diagnostic tools, degree of injury, and anatomic distribution of the injury, early and late complications, and requirement for ventilatory support. A total of 50 cases of caustic ingestion were identified (age range, 5 months-71 years). A biphasic distribution of the patients was noted; half were children under 5 years old and the remainder was adults. The most common caustic agent ingested was alkaline (42%) followed by acidic (32%) and chlorine bleach (26%). The most frequent cause for ingestion was accidental (67%) as opposed to attempt suicide (33%). All cases of attempted suicide occurred in adults. Most of them reported ingestion of large amounts of caustic substance. In the pediatric group, an association between the caustic agent and ethnicity was observed. Among Jewish children, alkaline cleaning agents were the most common cause (82%). Acetic acid was the most common substance ingested by the Arab children (100%). The findings of rigid esophagoscopy in 36 patients were as follows: first-degree esophageal injury in 16 (44%), second-degree in 6 (17%), third-degree in 7 (19%), fourth-degree in 6 (17%), and one (3%) was normal. Mucosal injury to the esophagus was worse in the acidic ingestion group as compared with the alkaline substance ingestion group with marginally statistically significant difference in the median degree of injury between the three types of ingested substances (P = .054). Mucosal injury to the esophagus was worse among patients who attempted suicide as compared with accidental ingestion with a statistically significant difference in the median degree of injury between the two reasons for ingestion (P = .002). Severity of injury from caustic ingestion damages depend on the type of ingested substance, which varies depending on ethnicity. Ingestion of caustic agents by children involves specific substances according to the season, cultural and religious festivals, and ethnicity. The majority of adult cases are intentional with more serious injuries and a higher rate of complications. In our series, ingestion of acidic substances and ingestion associated with suicide attempt had the most severe consequences.

Oesophageal Replacement in Children with Indolent Stricture of the Oesophagus

To evaluate the indications for and results of oesophageal replacement for acquired oesophageal stricture in children. This was a descriptive interventional study. Between 1987 and 2003, patients who had peptic or corrosive stricture were included in the study. Age and gender were analysed and any history of ingestion of caustic agents or untreated reflux was noted. Types of symptoms such as progressive dysphagia to solids and liquids and extent of respiratory infections were evaluated. Nutritional deprivation was also measured. Success or failure of dilatation at the time of endoscopy was taken into account. The criterion for oesophageal replacement was recurrence of stricture within 3 weeks of the previous dilatation. Patients were prepared with general supportive care. Feeding gastrostomy was performed in 12 patients who were severely malnourished. No patients underwent oesophagectomy of the strictured oesophagus. Short- and long-term complications were recorded. Of the 54 patients, 34 were male and 20 were female. Colonic conduit and reverse gastric tube were used in 27 patients each. Three patients had leak and were treated conservatively. Six patients developed anastomotic stricture but benefited remarkably from periodic dilatation and, in the long-term, remained symptom-free. Results were generally very gratifying. Most patients who require oesophageal conduit do well and catch up with their growth and development.

Clinical Characteristics and Predisposing Factors of Complications of Caustic Injury of the Upper Digestive Tract

Background: Accidental or suicidal ingestion of caustic agents is not uncommon. Caustic injury to the upper digestive tract can lead to severe stenotic sequelae. We investigated clinical characteristics, endoscopic findings, and predisposing factors of the development of complications of caustic injury. Methods: The medical records of 77 patients were reviewed who had been admitted because of caustic injury from March, 1993 to June, 2004 (male:female 35:42, mean age 46±17 years). All patients underwent endoscopic examinations within 24 hours after admission, and caustic injuries were graded according to Zargar's classification (grades 0-III).

Ingestion of caustic substances by adults.

Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. In this paper, we review demographic features and endoscopic results of the patients admitted to a university emergency department with a history of caustic substance ingestion between January 2000 and June 2003. Thirty-seven patients were included in this study. Twenty-one of the patients were female and 16 were male. The mean age of the patients was 30.9 +/- 14.7 years. The agents included sodium hypochlorite in 24 patients and hydrochloric acid in 13 patients. All the patients ingested these agents orally. The mean interval time of admission to emergency department after ingestion of caustic agent was 5.4 +/- 5.6 hours. Endoscopy was attempted in 37 patients. Endoscopic results were as follows: grade 0 in 8 (21.6%) patients, grade 1 in 17 (45.9%) patients, grade 2a in 5 (13.5%) patients, and grade 2b in 7 (18.9%) patients. We believe that early signs and symptoms after caustic substance ingestion are not consistent with the extent of damage, and endoscopy is the only reliable method to assess injury. It is important that efforts should be made to educate the public about the dangers of caustic substances so that their threat may be diminished.

Drug-Induced Esophagitis

Corrosive esophagitis is caused by the ingestion of caustic agents. The elderly consume a large number of medications that potentially could cause Drug-Induced Esophagitis (DIE). This article reviews the signs and symptoms, diagnosis, prognosis, and epidemiology of DIE. Drugs reported to cause DIE are reviewed, including alendronate, potassium chloride, antibiotics known to cause DIE, as well as others. Illustrative cases are presented.

Pneumatosis intestinalis: a review.

This review illustrates the changing paradigms in the understanding of the pathogenesis of pneumatosis intestinalis. Although many theories have been evoked, pragmatically there appear to be four major clinical and diagnostic imaging considerations. The most common and most emergent life-threatening cause of intramural bowel gas is the result of bowel necrosis due to bowel ischemia, infarction, necrotizing enterocolitis, neutropenic colitis, volvulus, and sepsis. In the stomach, intramural gas can be caused by emphysematous gastritis or ingestion of caustic agents. These situations represent surgical emergencies. Pneumatosis is found secondary to mucosal disruption presumably due to over-distention from peptic ulcer, pyloric stenosis, annular pancreas, and even to more distal obstruction. Disruption can also be caused by ulceration, erosions, or trauma, including the trauma of child abuse. Disruption can also be iatrogenic from intracatheter jejunal feeding tubes, stent perforation, sclerotherapy, or surgical or endoscopic trauma. In these cases, the gas may be focal or linear. Treatment depends on the extent of the disruption and the underlying cause. A more subtle form of mucosal disruption may occur due to mucosal erosions and also to defects in intestinal crypts secondary to acute and subclinical enteritides that allow intraluminal bacterial gas under pressure to percolate into the bowel wall layers, particularly the submucosa (29). Pneumatosis, often linear or cystic in appearance, is seen with increased frequency in patients who are immunocompromised because of steroids, chemotherapy, radiation therapy, or AIDS. In these cases, the pneumatosis may result from intraluminal bacterial gas entering the bowel wall due to increased mucosal permeability caused by defects in bowel wall lymphoid tissue. Clinical and imaging findings are important in the differentiation of this transient pneumatosis from fulminant life-threatening causes in this subset of patients. A pulmonary cause must still be considered in cases of chronic obstructive pulmonary disease, asthma, and cystic fibrosis. It can occur with barotrauma and after chest tube placement. It may relate to increased intrathoracic pressure associated with retching and vomiting. The possibility remains that occasionally the origin of pneumatosis intestinalis will remain cryptogenic--caused but unexplained.

Caustic Ingestion Injuries

Ingestion of caustic agents causes more than 5000 injuries yearly. There is little that the physician can do acutely to attenuate the severity of the internal injuries, but the physician must intensively monitor the patient and react quickly to treat laryngeal burns or transmural penetration of esophageal or gastric burns. Esophageal strictures may appear at any time after the second week. No therapy has been shown to reduce the incidence of strictures. A policy of vigilant anticipation and early dilatation of developing strictures is recommended.

Esophagocoloplasty for cicatricial stenosis after chemical injury

Our experience with esophageal replacement by transposition of the right colon with a segment of ileum in patients with cicatricial esophageal strictures caused by the ingestion of caustic agents has been discussed. We demonstrated, by means of the D-xylose test, that the length of ileal segment did not adversely affect the absorptive ability of the intestine, which returned to the preoperative level shortly after the operation and even exceeded that level 12 months thereafter.

Caustic agent ingestion calls for esophagoscopy

Caustic agent ingestion calls for esophagoscopy

Caustic agent ingestion calls for esophagoscopy

Each year, more than 5,000 American children aged 5 years and under consume cleaning products or drain decloggers. The result is often esophageal burn which, if not treated quickly and aggressively, can progress to complications. In a paper presented to the annual meeting of the American Broncho-Esophagological Association in Palm Beach, Fla, Jeffrey S. Adam, MD, senior resident in otolaryngology, Ohio State University College of Medicine, Columbus, asserted that overtreatment of such cases is far preferable to undertreatment and that esophagoscopy of any child suspected of having consumed a caustic compound is an absolute necessity. Adam reported on 402 patients at Children's Hospital in Columbus who were evaluated retrospectively for possible esophageal burns after ingesting caustic agents (most commonly Liquid Drano, a 20% sodium hydroxide solution). Results of esophagoscopy were normal for 330 (82% ) of the children. However, findings were abnormal for 72 (18% ) of the children, most of