Ingestion Of Caustic Material Research Articles

Non-hypertrophic gastric outlet obstruction in the paediatric population: a case series with focus on management

BackgroundNon-hypertrophic gastric outlet obstruction (GOO) in children is rare and usually presents beyond infancy. Aetiology is variable, and management is not well established due to its rarity.MethodsWe aimed to conduct a descriptive study of these cases within our geographic area. It is a retrospective chart review of all children with non-hypertrophic gastric outlet obstruction presenting to three hospitals in northwest Syria during the period 2019–2023. Demographics, presentation, and management data were extracted.ResultsTwelve cases were identified, eight males, with age range 1–12 years and follow-up range 3–42 months. Eight patients had a history drinking battery acid and one with ingestion of high-dose ibuprofen. The other three had no clear aetiology. Five patients improved by endoscopic balloon dilatations (EBD), and seven needed surgeries. All those who had successful EBD were treated within 3 weeks of ingestion.ConclusionNon-hypertrophic GOO in children is rare and mostly related to caustic material ingestion. Treatment by endoscopic balloon dilatation is likely to be successful if done within 3 weeks from caustic ingestion. After that period, often surgery is needed.

Catastrophic Caustic Ingestion: A Case Report.

IntroductionThe majority of oral ingestion of caustic material by adults is intentional, and the aftermath varies widely with potentially fatal results. Injuries range from superficial burns of facial and oropharyngeal structures to extensive necrosis of the gastrointestinal tract. Management focuses on the identification of the ingested substance and prompt treatment and supportive care of the multiple complications stemming from the ingestion. Complications following caustic ingestion include both immediate and long term.Case presentationA fifty-seven-year-old man presented following intentional ingestion of drain cleaner. The patient was intubated and underwent emergent esophagogastroduodenoscopy [EGD], which revealed extensive damage to his oesophagus and stomach. He survived his initial injury but had a prolonged hospital course and ultimately died after developing tracheoesophageal and bronchooesophageal fistulas which were too extensive for surgical repair.ConclusionThe sequelae of caustic ingestion can be minor or severe, both immediate and delayed. Despite appropriate prompt management and supportive care, patients may die as a result of the initial injury or subsequent complications.

Esophageal caustic injuries in pediatrics: a sobering global health issue.

Caustic material ingestion by children is considered a global healthcare issue, especially in low-to-middle income countries. The aim of this article was to review the epidemiology, prevention, and management of caustic material ingestion in pediatric patients, comparing low-to-middle income countries with high-income countries. We conducted an English literature review using PubMed with the following keywords: (caustic OR corrosive) AND ingestion AND (pediatric OR pediatric). Our search retrieved 253 citations; all abstracts were screened by the authors, and 52 articles were finally included in our review. Prevention is key in tackling this issue, but legislation is scarce in low-to-middle income countries. Diagnosis of caustic ingestion is mostly achieved using flexible endoscopy, computed tomography, and endoscopic ultrasound, but access is limited in low-to middle income countries and diagnosis is often delayed. After stabilizing patients, the mainstay of treatment is graded endoscopic dilatation, and rarely, esophageal replacement. We concluded that caustic ingestion represents a serious condition where prevention is the key. Once a child suffers an injury, rapid and careful evaluation of the injury with endoscopy, and a course of close observation and dilations if needed, will often avoid esophageal replacement. When necessary, the stomach is the best first option if it is viable, followed by the colon, and finally, the jejunum.

Corticosteroids for Preventing Caustic Esophageal Strictures: Systematic Review and Meta-analysis.

Caustic ingestion can have a complicated clinical course. Corticosteroids are widely used but there is uncertainty about its role in preventing esophageal stricture formation following caustic ingestion. This systematic review and meta-analysis assessed the available clinical evidence regarding the efficacy and safety of corticosteroids for preventing esophageal strictures following caustic injury. We assessed randomized controlled trials (RCTs) that compared corticosteroids versus no corticosteroids in the prevention of esophageal stricture formation following caustic ingestion. We searched the following databases from inception to March 2017: PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Two reviewers retrieved eligible articles, assessed risk of bias, and performed data extraction. The main outcome measure was the prevention of esophageal stricture formation. The search identified 763 citations. Three RCTs involving 244 participants met the inclusion criteria. There was no benefit of corticosteroids in the prevention of esophageal strictures following the ingestion of caustic materials (risk ratio [RR] = 0.63, 95% CI = 0.29-1.37). The available evidence does not support the use of corticosteroids for the prevention of esophageal strictures following caustic ingestion. The overall quality of the evidence is limited because of methodological weaknesses and small sample sizes in the primary studies.

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.

Research Paper: Effectiveness of Corticosteroid Therapy for Caustic Esophageal Injury

Background: Delayed caustic injury complications are common, especially in developing countries, and several treatments have been proposed to prevent the resulting esophageal strictures so far. Although inflammatory nature of caustic injury makes the anti-inflammatory agents a viable option, few studies have investigated these agents. High-dose corticosteroids therapy for reduction of stricture formation in the esophagus after the ingestion of caustic material is still a controversial topic. In this regard, this study aimed to determine the impact of high doses of methylprednisolone in preventing esophageal stricture. Methods: A total of 112 patients with grade II esophageal caustic injury, diagnosed by esophagogastroscopy within 24 hours of injury, were enrolled in our study. The treatment group (n=44) received methylprednisolone (1 g/d for 3 days), pantoprazole, ceftriaxone, and metronidazole and the control group (n=58) received the same regimen excluding methylprednisolone. Endoscopic and radiologic findings were used to compare the severity of the damage to the esophagus and stomach between the two groups. Results: After 8 months of follow-up, stricture development was observed in 3 (5.6%) patients in the treatment group and in 11 (19%) patients in the control group. The difference was statistically significant (P=0.038). The gastric outlet obstruction was observed in 4 (7.4%) patients in the treatment group and in 19 (32.7%) patients in the control group. Again, the difference was statistically significant (P<0.05). There were not any side effects due to the high doses of methylprednisolone in the study group. Conclusion: High doses of methylprednisolone can prevent the development of esophageal stricture in grade II of caustic injury.

Treatment Modalities for Post Corrosive Esophageal Strictures: 5 Years Experience

Background: Management of post-corrosive esophageal strictures represents a major challenge for clinicians. There are many options for treatment as dilatation alone or dilatation with injection of corticosteroids, stent placement, and surgery. The aims of the study: This is a retrospective study to assess the success rate of different treatment modalities for post-corrosive esophageal stricture including: endoscopic dilatation, stenting or surgery and to define any complications. Methods: Clinical and endoscopic data for patients with post-corrosive esophageal stricture admitted to the endoscopy unit between September 2012 and September 2017 were collected. Retrospective analysis of data was done to detect the types of treatment, success rate and any detectable complications. Results: A total of 50 patients with their ages ranged between 3 and 20 years were included in this study. Male patients represented 54% (27 patients) and females were 23 (46%). The cause of caustic material ingestion was mainly accidental (47 patients, 94%) and only 3 patients were suicidal (6%). Dilatation was successful in most cases either with or without injection of corticosteroids (39 patients, 78%). Stenting was a good option in cases of refractory or recurrent dilatations (11 patients; 22%) with excellent results. Surgery rarely needed (only in one patient) and only when dilatation and stenting failed. Conclusions: Endoscopic treatment of post-corrosive esophageal stricture has a good result and low rate of complications. The covered self-expandable metal stent (SEMS) is a good option in cases of refractory strictures, surgery rarely needed and after failure of previous modalities.

Tracheal Injuries

Tracheal injuries, although uncommon, are yet very important since they can lead to immediate death. With the improvement of prehospital medical care the incidence is expected to increase in time. Blunt or penetrating trauma, iatrogenic causes, strangulation, burns and caustic material ingestion give rise to tracheal injuries. Management is either conservative or surgical. Mainstay of the tracheal injuries is suspicion, early diagnosis and prompt management.

Caustic Material Ingestion Injuries- Paradigm Shift in Diagnosis and Treatment

Abstract Despite efforts to reduce exposure to corrosive household products there are still 5,000 new cases of severe caustic material ingestion injuries (CMI) in the United States each year. If managed inappropriately the associated morbidity and mortality are substantial. In this review we will try to highlight the clinical presentation, diagnostic and management of caustic material ingestion injuries. We will focused on the current trends in the evaluation and management of patients that become more conservative compared to previous decades.

Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion.

Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports.In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.

The Case Files

The Case Files

Mercaptoethylguanidine attenuates caustic esophageal injury in rats: a role for scavenging of peroxynitrite

Introduction After ingestion of caustic material, tissue damage is caused by reactive oxygen species and reactive nitrogen species such as peroxynitrite. Mercaptoethylguanidine (MEG) is a well-known scavenger of peroxynitrite. This study was designed to determine whether MEG has a beneficial effect on caustic esophageal injury. Materials and Methods Forty-five rats were allocated into 3 groups: sham-operated, untreated, and treated groups. Caustic esophageal burn was created by instilling 15% NaOH in the distal esophagus. The rats were left untreated or treated with 10 mg/kg per day MEG intraperitoneally for 5 days. All rats were killed at 28 days. Efficacy of the treatment was assessed both histopathologically and biochemically. Results Of 15 rats, 6 (40%) died in the untreated group, and only 1 (7%) rat died in the treated group. The stenosis index (SI) and the histopathologic damage score were significantly lower in the MEG treatment group than the untreated group, which showed a correlation with tissue hydroxyproline level. In the untreated group, tissue oxidative stress parameters (malondialdehyde and protein carbonyl content) were significantly higher; and antioxidant enzyme activities (superoxide dismutase and glutathione peroxidase) were significantly lower. Administration of MEG ameliorated oxidative stress parameters and antioxidant enzyme activities. Urinary nitrate and nitrite levels increased in the treated and untreated groups in the first 3 days, suggesting increased nitrosative stress; but at the fourth day, nitrate and nitrite level reached control values in the treated group. Conclusion Peroxynitrites play an important role in the healing process of caustic esophagitis. As a peroxynitrites scavenger, MEG potentially might be a useful adjuvant agent in the treatment of esophageal caustic burn by modulating the antioxidant defense mechanism.

Mercaptoethylguanidine Attenuates Caustic Esophageal Injury in Rats; A Role for Scavenging of Peroxynitrite

IntroductionAfter ingestion of caustic material, tissue damage is caused by reactive oxygen species and reactive nitrogen species. Mercaptoethylguanidine (MEG) is a scavenger of peroxynitrite. Thus, this study was designed whether MEG has a beneficial effect on caustic esophageal injury.Methods45 rats were allocated into 3 groups; sham‐operated, untreatment and treatment groups. Caustic esophageal burn was created by instilling 15% NaOH in the distal esophagus. The treatment group treated with 10 mg/kg/day MEG i.p. for 5 days. All rats were killed at 28 days. Efficacy of the treatment was assessed by histopathologically and biochemically.ResultsThe stenosis index and the histopathologic damage score were significantly lower in the MEG‐treatment group which showed a correlation with tissue hydroxyproline level. In the untreatment group, tissue oxidative stres parameters (malondialdehyde and protein carbonyl content) were significantly higher, antioxidant enzymes activities (SOD and GSH‐Px) were significantly lower than trreatment group. Urinary Nitrate and Nitrite (NOx) levels increased in the treatment and un‐treatment group at the first three days.ConclusionPeroxynitrites play an important role in the healing process of caustic esophagitis. MEG might be used a potential adjuvant agent in treatment of esophageal caustic burn by modulating antioxidant defense mechanism.

Caustic esophagitis in two siblings:Munchausen syndrome by proxy

Background and aim: Recurrent corrosive esophagitis is a rare condition among children and may be due to child abuse. The Munchausen Syndrome by Proxy (MSBP) is special form of child abuse with variety of symptoms. It has challenging diagnostic process and needs a high clinical suspicion. When it is identified by physician, institutional child protection team must involve into the management of the case. Case report: We present the two siblings with recurrent esopahigitis. One of them died due to severe gastrointestinal bleeding. Other had severe esophageal stricture and oral lesions. Their mother fed both of them with caustic material at various time intervals. Both babies were treated in our hospital several times with the admission of their mother. Conclusion: This is the probably the first case report of Munchausen Syndrome by Proxy (MSBP) with caustic material ingestion of two siblings. Determining the exact cause of such cases is very difficult and physician must suspect child abuse in this situation.

Risk Factors Affect Outcome of Esophageal Injuries Caused by Caustic Ingestion in Children

Purpose: Ingestion of caustic materials is a worldwide challenge. The study aim was to identify the factors that influence the outcome and prognosis of esophageal injuries after caustic ingestion in children. Methods: We retrospectively reviewed all files of patients with history of caustic ingestion, their endoscopy results and follow up, who were admitted at Pediatrics Gastroenterology ward of Aboozar Children's Hospital, Ahwaz, South -Western of Iran. Results: During 10 years (October 1998- 2008) a total of 81 children (mean 2.7, range 1-5 y), 46 male, with history of caustic ingestion were enrolled in our study. Ingestable alkaline were drain, pipe, oven, grill and barbecue cleaners, dish washer detergent and bleaches (Totally 61%) and acidic materials as drain openers, toilet cleaners and battery liquid (Totally 39%). The grade(G) of esophageal injury with regard of the ingested caustic materials was: GO (history of ingestion, no injury, 18.5% in bleaches ingestion), G1 (edema and erythema, no transmucosal injury, 11% in very small amount acid and dish washer ingestion), G2 a/b (transmural injury, hemorrhage, circumferential ulceration, 64% in large amount of acid ingestion and vomiting, alkaline ingestion and delay in hospital admission), G3 a/ b (scattered deep ulceration and necrotic tissue 6.5% in large amount of alkaline ingestion and vomiting and/ or delay in hospital admission). Our follow up study showed that 11 (13.5%) cases developed esophageal stricture about 3 weeks after caustic ingestion despite proper treatment including dexametasone and antibiotic (Picture). The stricture confirmed by a second endoscopy and contrast media study. All these 11 patients had grade 2+ esophageal injury. Dilatation by boogies or balloon was done for these cases and 2 of them needed further surgery treatment which 1 of them died.FigureConclusion: Caustic ingestion by children is a worldwide preventable medical problem. In this study, we found that the alkali, large amount of ingested caustic agent, delayed referral to hospital and treatment including vomiting after ingestion worsen the outcome and prognosis. Prevention is paramount.

Clinical evaluation and management of caustic injury in the upper gastrointestinal tract in 95 adult patients in an urban medical center

Caustic ingestion causes a wide spectrum of injuries; appropriate treatment varies according to the severity and extent of the injury. This retrospective study of adult patients with caustic injury presents the endoscopic findings, treatment regimen, and clinical outcome. Over a 28-year period, 95 consecutive adult patients admitted to an urban emergency hospital for ingestion of caustic materials were studied. Each patient underwent early endoscopy and the injury was graded for severity. There were 61 men and 34 women with an average age of 37.2 years (range 17 to 81). Ingestion was due to a suicide attempt in 49 patients and accidental in 46 patients. Ten patients showed no mucosal damage. The remaining 85 patients had grade I superficial injury in 47 patients, grade II moderate injury in 25 patients, and deep grade III injury in 13 patients. The ingestion of strong acid or strong alkali often produced deep grade III changes while bleach, detergent, ammonia or other substances usually caused grade I injury. Operative interventions were required for 11 patients with grade III injury and 6 patients with grade II injury. Endoscopic grading was predictive for the onset of complications including late esophageal stricture. There were no complications due to endoscopy; one patient with grade III and multiple comorbidities died from multiple organ failure. Upper gastrointestinal endoscopy after caustic ingestion should be performed early to define the extent of injury and guide appropriate therapy. Grade I injuries heal spontaneously. Grade II injuries may be treated conservatively but repeat endoscopy helps define when intervention is needed. Grade III injuries ultimately require surgical intervention.

Black oesophagus: a rare disorder with potentially fatal outcome

Black oesophagus is a rare pathological condition of unknown aetiology characterised by a full length, circumferential black discolouration of the entire oesophageal mucosa. The disease is sporadically encountered during upper gastrointestinal endoscopy. We used conventional histology, enzyme histochemistry and immunohistology to examine five autopsy cases (four males, one female; age range 43-86 years) of black oesophagus. On microscopical examination, the esophageal mucosa was entirely necrotic with demarcation by a leukocytic infiltrate in the upper submucosa. This infiltrate was dominated by neutrophilic granulocytes and scattered macrophages lacking haemosiderin deposits, placing the noxious mucosal injury in a time frame of approximately 24-72 h prior to death. Black oesophagus was established as the immediate cause of death in one case due to desanguination from the oesophagus and significantly contributed to the fatal outcome in a second case. Apart from a history of chronic alcohol consumption in four cases, no other pre-existing pathological or debilitating conditions could be established. The remarkably consistent pathomorphological picture of the disease seems to be the result of impaired microcirculation of the oesophageal mucosa due to prolonged hypotension of variable aetiology. The diagnosis of black oesophagus requires exclusion of other causes such as ingestion of caustic materials and should be based on histological examination.

What is the utility of selected clinical and endoscopic parameters in predicting the risk of death after caustic ingestion?

Despite the increasing use of early esophagogastroduodenoscopy, the prognostic evaluation and triage of patients who have ingested caustic material is challenging. We evaluated the usefulness of selected clinical and endoscopic parameters in predicting the risk of death after ingestion of caustic substances. Clinical and endoscopic parameters were obtained from the records of all the patients admitted to our endoscopy unit because of ingestion of caustic material between 1 March 1982 and 30 June 1999. Parameters significantly associated with the risk of death by univariate analysis were entered into a multivariate logistic model. The independent predictors of death by multivariate analysis were used to build a risk score system. Out of 210 patients, 13 underwent emergency surgery (6.2 %) and 25 died (11.9 %). Multivariate analysis identified the following as independent predictors of death: age (10-year intervals; odds ratio [OR] 2.4; 95 % confidence interval 1.4 - 4.1), ingestion of strong acids (OR 7.9; 1.8 - 35.3), white blood cell count at admission > or = 20 000 units/mm3 (OR 6.0; 1.3-28), deep gastric ulcers (OR 9.7; 1.4 - 66.8), and gastric necrosis (OR 20.9; 4.7 - 91.8). The values of the risk score system devised from the results of the multivariate analysis ranged from 1 to 16. No patient scoring < 10 points died and just one of the patients scoring > 14 points survived. Age, ingestion of a strong acid, leucocytosis, deep gastric ulcers, and gastric necrosis are predictive of death after caustic ingestion. A risk score system including these predictors may be useful in prognostic evaluation.

A Controlled Trial of Corticosteroids in Children with Corrosive Injury of the Esophagus

It is controversial whether treatment with corticosteroids reduces stricture formation in the esophagus after the ingestion of caustic material. We conducted a prospective study over an 18-year period in which 60 children (median age, 2 years) with esophageal injury from the ingestion of caustic material were assigned randomly to treatment either with or without corticosteroids. The corticosteroids were given initially as prednisolon (2 mg per kilogram of body weight per day intravenously) and then as prednisone orally to complete a three-week course. All patients were evaluated by esophagoscopy within 24 hours of the ingestion. Those with moderate or severe esophageal injury had repeat esophagoscopy and barium swallow at follow-up. Esophageal strictures developed in 10 of the 31 children treated with corticosteroids and in 11 of the 29 controls (P not significant). Four children in the steroid group and seven in the control group eventually required esophageal replacement (P not significant). All but 1 of the 21 children with strictures had severe circumferential burns on initial esophagoscopy. There appears to be no benefit from the use of steroids to treat children who have ingested a caustic substance. The development of esophageal stricture was related only to the severity of the corrosive injury.

Esophagitis Secondary to Ingestion of Caustic Material

The records of 176 patients admitted to Grady Memorial Hospital over a 10-year period with a history of ingestion of corrosive material were reviewed. Esophagoscopy was performed in 168 patients an average of 15 hours after ingestion. In 94 patients, no esophageal burn was found. Seventy-four others had injury of the esophagus of varying degree; 3 of these had no evidence of oropharyngeal burn. The patients with esophageal injury were treated with steroids for two weeks and antibiotics for 5 days. No complications resulted from esophagoscopy or steroid therapy in any patient. Stricture did not develop in any of the patients in whom esophagoscopy was negative. Documented stricture occurred in 29 patients with esophagoscopic evidence of esophageal burns, 7 of whom did not respond to periodic esophageal dilation and subsequently underwent esophageal bypass. Three patients had symptoms and signs of gastric perforation on the first, sixth, and eighth days after ingestion, respectively, and at laparotomy all of them were found to have severe gastric injury. One of these patients died on the postoperative day 28; this was the only death among all patients seen with history of ingestion of corrosive material. This study suggests that with early esophagoscopy, approximately 55% of patients who ingest corrosive material can be spared the agony and prolonged treatment of possible esophageal injury. Appropriate management will result in preservation of the esophagus in most patients.