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Abstract
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INTRODUCTION: Ingestion of caustic is a frequent and serious injury, which can occur a fatal issue. Endoscopy is very important in management of corrosive injuries. Aims: To evaluated our experience in caustic injuries of upper aerodigestive tract and analyzed the lesions.
PATIENTS AND METHODS: This study has included 483 patients treated during ten years. There were 247 children and 236 adults. The mean age of adults was 26.7 years (16-78 years). The sex ratio was 0.2. The mean age of children was 3.5 years (18 month-15 years). All the patients have had first esogastroduodenal endoscopy at j1. The control endoscopy was realized at j21, when the lesions were grade IIB or III as surveillance protocol. A barium swallow was realized at j30 when a gastric or esophageal stenosis was found to appreciate the characteristics of the stenosis. The esophageal stenosis was dilated one month after caustic ingestion with Savary Gilliard dilator. The gastric stenosis underwented a chirurgical treatment.
RESULTS: The most common substance drunken is strong alkali (decapant de four) in 77.4%. The strong acid was ingested in 21%. In adults, the caustic ingestion was accidentaly in 63% and for suicide in 37% of the cases. Among children the caustic ingestion was an accident in 85% and for suicide in 15% (teenagers) of the cases. Esophageal caustic injuries were found in 64%. The lesions were very serious in 58% (grades IIB and III) of the cases and less in 42% (grades I and IIA). In 36%, there was not any lesion of upper aerodigestive tract. Gastric lesions were objectived in 12%. All the patients with severe lesions were hospitalized and had exclusion of oral nutrition (resting on the higher tube digestive). Esophageal and gastric stenosis were respectively found in 67.5 and 76% after endoscopy control of lesions IIB and III. The results on long-term of dilatation in esophageal stenosis were very good in 80%; in 20%, the dilation failed then, the patients underwent esophagoplaty. The severe gastric stenosis underwent a gastrectomy or gastroenteroanatomosis.
CONCLUSION: Ingestion of caustic is a frequent and serious injury whith can occur severe lesions of the gastroesophageal tract. The most common sequella are esophageal stenosis, which occurs a severe dysphasia and a great weigth less. © 2009 Springer Verlag France.
Language: fr |