Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion
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WORLD JOURNAL OF EMERGENCY SURGERY
COMMENTARY
Open Access
Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion Yoram Kluger1*, Ofir Ben Ishay1, Massimo Sartelli2, Amit Katz1, Luca Ansaloni3, Carlos Augusto Gomez4, Walter Biffl5, Fausto Catena6, Gustavo P. Fraga7, Salomone Di Saverio8, Augustin Goran9, Wagih Ghnnam10, Jeffry Kashuk11, Ari Leppäniemi12, Sanjay Marwah13, Ernest E. Moore14, Miklosh Bala15, Damien Massalou16, Chirica Mircea17 and Luigi Bonavina18
Abstract 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.
Introduction/Background Caustic ingestion may result in significant injury to the entire gastrointestinal tract, but most significantly the upper tract, including the oropharyngeal cavity, larynx, esophagus, and stomach. The majority (68 %) of cases worldwide involve children as a result of unintentional, accidental ingestion of caustic substances. The remainder of cases reported are adults with psychiatric disturbances, some after suicide attempts, or alcoholics [1, 2]. As expected, the resultant severity of injury in caustic ingestion is determined by the type of ingested substance the amount and the time of tissue exposure. Due to the substantial morbidity and mortality associated with these injuries, the medical community demanded legislative action. Through persistent efforts, the Federal Caustic Act of 1927 was enacted, requiring appropriate labeling of caustic substances, such as lye. Subsequently, the Poison Prevention Packaging Act of 1970 directed the US Consumer Product Safety Commission to require childproof containers and improved labeling of caustics and other potentially * Correspondence: [email protected] 1 Rambam Health Care Center, POB 9602, Haifa 31096, Israel Full list of author information is available at the end of the article
harmful household products. These legislative acts caused dramatic decline in the occurrence of this type of injury in developed countries. However, in developing countries the incidence is still much higher [3]. While the injury pattern frequently seen in children is usually relatively minor due to smaller amounts ingested, in adults much larger quantities of the caustic substance frequently result in severe injury [3–5]. Injury caused by alkali or acid results in a different injury pattern. For example, alkali causes almost no irritation to the oral cavity, which usually results in larger ingested volumes entering the GI tract. Furthermore, because Alkali materials are thicker, they lead to longer exposur
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