Corrosive ingestion managements in children
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REVIEW ARTICLE
Corrosive ingestion managements in children Ibrahim Uygun1 · Salih Bayram2 Received: 8 December 2019 / Accepted: 26 April 2020 © The Japan Esophageal Society 2020
Abstract Corrosive (caustic) material ingestion remains a major health issue, particularly in developing countries. The management strategy after corrosive ingestion should be planned according to the signs and symptoms. The management of corrosive ingestion based on endoscopic grading, nothing by mouth, and barium studies should be abandoned. With the new management protocol, esophageal stricture can be predicted with high accuracy using the simple new prognostic DROOL score (≤ 4) rather than endoscopic grading, reduced by immediate oral feeding as soon as the patient can swallow saliva instead of nothing by mouth, diagnosed earlier (10–14 days) by fluoro-endoscopic balloon-assisted esophageal examination for patients with persistent dysphagia instead of relying on a barium study (≥ 21 days), and adequately treated by initiating balloon dilation earlier during the same anesthesia procedure. Fluoroscopically guided balloon dilatation with large balloons (18–20 mm) seems to be safe, with a low frequency of complications and a high success rate. If dilatation fails after a few months, esophagectomy and replacement surgery using the stomach should be considered. The increased risk of developing esophageal carcinoma after ingestion of corrosive substances should be kept in mind. Keywords Esophagography · Esophageal stenosis · Esophagitis · Sodium hydroxide · Esophageal screening
Introduction
Corrosive substances
Corrosive (caustic) substances are chemical agents that cause tissue damage upon direct contact. Corrosive substance ingestion in children usually occurs by accident. Corrosive-related accidents continue to be a life-threatening problem, especially in children under 6 years of age, particularly in developing countries [1–14]. This review aims to investigate the epidemiology, clinical features, and current early and late treatment strategies for corrosive ingestion in children.
Corrosive substances are chemical substances that cause damage upon direct contact with the internal and external organs of the body. Although they are defined as caustic substances, referring to these chemicals as corrosive substances is more appropriate because caustic substances can imply only alkaline substances. Corrosive substances can damage the body in solid, liquid and gaseous forms. Most frequently, corrosive accidents occur due to the ingestion of liquid corrosives. Serious accidents may also occur due to the ingestion of solid forms of corrosives that are sold as powders, granules or tablets or due to inhalation of vapor from liquid corrosives (Table 1, Fig. 1). The amount, physical state, and especially the pH of corrosives greatly affect the location and severity of tissue damage [3, 7, 10]. For example, a pH > 12 or 12 h) and reluctance to eat (> 24 h) may be signs of esophageal stricture development [5]. Symptoms of dyspnea, such as strid
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