Corrosionof Esophagus in Children

Overview

Patients with the diagnosis of suspect corrosion of esophagus form 15% of allemergency hospitalization patients at our clinic. In view of the severity of the disease, its possibleconsequences and complications, all cases of suspected swallowing of caustic compounds are givenpriority for early diagnostic-therapeutic measures at specialized otolaryngology ward, whichdisposes of the emergency unit experienced in poisoning, and a surgery ward capable of operationon the thoracic part of esophagus. The basic procedures include particularly the timely rigidesophagoscopy for estimating the degree of corrosion; flexible esophagoscopy is considered ofposing a risk. The esophagoscopy finding enables to classify the corrosion into four degreesaccording to our working classification. The patients affected by corrosion of the Ist degree are onlysubject to observation, whereas the finding of corrosion of the IInd or IIIrd degree indicates thatthe nasal-gastric probe is to be introduced for the period of six weeks and the therapywith two-stagecorticoid treatment and intravenous administration of antibiotics during the first week after theinjury. In cases of corrosion of the IVth degree the probe is applied for a longer period of timetogether with an effort to maintain esophagus as wide as possible and the replacement of esophagusis considered in collaboration withsurgeons at the most suitable period of time.Edema of the entry into larynx is the most frequent acute complication of corrosion of swallowingpassages; it is treated by a pharmacological intervention and, whenever insufficient, intubation or,exceptionally, tracheotomy must be made to secure respiratory pathways free. A post-corrosionstricture, which mostly responds to a balloon dilatation favorably, is the most frequent late complication.Extensive strictures limiting the esophagus lumen, which deteriorate the possibility forintake of food and do not respond to balloon dilatation favorably, represent indication for esophagusreplacement. Mediastinitis and aorta-esophagus fistula represent the most serious complications.The authors then analyze a cohort of children patients treated for suspect corrosion of esophagustreated at the Otolaryngology Clinic, 2nd Medical Faculty, Charles University, in the years 1991 to2001. All the patients were treated according to a uniform diagnostic-therapeutic protocol.In the period of observation, 275 patients were examined. When the early rigid esophagoscopy wasapplied, negative findings were observed in 156 (56.7%) patients, corrosion of the Ist degree in 47(17.1%) patients, corrosion of the IInd or IIIrd degree in 62 (22.5%) patients and the IVth degree in10 (3.6%) patients. Two patients with corrosion of the IVth degree died. The death was caused byuntreatable mediastinitis withde veloping multiorgan failure. One female patient, who sufferedfrom corrosion of the IVth degree is still affected by a severe post-corrosion stricture which maycan not be influenced by the balloon dilatation. All the other patients are completely without anycomplaints.

Key words:
corrosion of esophagus, children, nasal-gastric probe, rigid esophagoscopy.