Management of burn injuries in esophagus

Accidental ingestion of corrosives is frequent reported in children under 5 years (commonest in toddlers) leading to high morbidity and mortality. According to the data presented by American Association of Poison Control, each year over 200,000 cases of exposure to caustic cleaning agents is reported in United States which includes acids and alkalis). Each year, 5000 to 15,000 cases of caustic ingestions are admitted in hospitals in United States. It has also been observed that alkali agents are consumed 11 times more frequently than acid. Corrosive ingestion is also fairy common among adults who consume cleaning agents, bleaching solutions or drainers for suicidal reasons and less commonly due to accidental or homicidal reasons.

What is the patho-physiology of burn injury due to corrosives?

The intensity and severity of burn injury due to corrosives is dependent upon the duration of exposure, strength of corrosive and area of body involved. In case of ingestion of corrosives, the risk of tissue damage and destruction is very high. Corrosives mostly cause second degree or third degree burns that may develop soon after ingestion and worsen with time. Study conducted by Keith W. Ashcraft (3) suggested that mere 10% concentration of common caustic solutions like KOH, Sulfuric acid and sodium hydroxide can lead to extensive damage to esophagus.

What are the complications of corrosive ingestion?

The risk of complications is highest with strong alkalis and acids. Most victims die of pulmonary edema or cardiac shock; however, with early intervention and management, complications can be minimized. Depending upon the concentration of corrosive, first degree burns, second degree burns or third degree burns of esophagus may occur. Research conducted by Lucian Leape (2) suggested that an exposure of just one second and quantity of as little as 1 ml can lead to extensive esophageal necrosis.

Common complications include:

-          Esophageal burns

-          Stricture formation

-          Esophageal necrosis

-          Pulmonary edema

-          Pyloric stenosis

-          Necrosis of upper lip and oral cavity

-          Permanent disfigurement or scarring of face and neck region.

How to manage severe burn injuries due to corrosives?

There is a lot of debate regarding management of second degree burns soon after injury or after some time.

-          Avoid any type of manipulation like nasogastric aspiration

-          Maintain input and output chart and maintain adequate hydration to decrease the risk of circulatory collapse

-          Arrange cardio- pulmonary support

-          Initiate high- dose steroid therapy (early start of steroid therapy decreases the risk of stricture formation as suggested by the research published in the New England Journal of Medicine (1)

-          Initiation of prophylactic antibiotics.

It is highly recommended by healthcare providers to keep all the corrosives out of reach of children. Moreover, always label the corrosives or chemicals (if these agents are not in original container). Statistical data indicated that 75% of the corrosives (4) when ingested were not in their original container. Last but not the least, always use products with child- proof covers/ lids.

References:

1. Anderson, K. D., Rouse, T. M., & Randolph, J. G. (1990). A controlled trial of corticosteroids in children with corrosive injury of the esophagus. New England Journal of Medicine, 323(10), 637-640.

2. Leape, L. L., Ashcraft, K. W., Scarpelli, D. G., & Holder, T. M. (1971). Hazard to health—liquid lye. New England Journal of Medicine, 284(11), 578-581.

3. Ashcraft, K. W., & Padula, R. T. (1974). The effect of dilute corrosives on the esophagus. Pediatrics, 53(2), 226-232.

4. Casasnovas, A. B., Martinez, E. E., Cives, R. V., Jeremias, A. V., Sierra, R. T., & Cadranel, S. (1997). A retrospective analysis of ingestion of caustic substances by children. Ten-year statistics in Galicia. European journal of pediatrics, 156(5), 410-414.

This entry was posted in Uncategorized. Bookmark the permalink.

Comments are closed.