Salicylic acid
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» Salicylic acid
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Oesophageal stricture (first report) following accidental ingestion in paediatric patients: 2 case reports
Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of oesophageal stricture associated with salicylic acid. The WHO ADR database did not contain any reports of oesophageal stenosis associated with salicylic acid.
Two boys developed oesophageal strictures after accidental ingestion of salicylic acid-containing products. A 3-year-old boy ingested an unknown quantity of a professional strength callus remover fluid containing salicylic acid, which was stored in a Gatorade bottle. He was found crying and complaining of pain in his throat and mouth. He vomited on transit to an emergency department, and again after arrival. Laboratory investigations revealed a salicylate concentration of 1.1 mg/dL on arrival; 12 hours later, the salicylate concentration had decreased to < 1.0 mg/dL, indicative of low dose salicylic acid ingestion. His throat pain worsened, and he began gagging and vomiting, and refused food intake. Examination of his oropharynx revealed erythema, with several small ulcers in the posterior oropharynx. He was hospitalised and underwent upper endoscopy the next morning, about 18 hours after ingestion. Findings included superficial white plaques without perforation or deep ulcerations in his upper and lower oesophagus, and circumferential erythema and shallow plaques superior to the gastro-oesophageal junction. He received lansoprazole and sucralfate, and was discharged on a soft diet on day 4. However, he started vomiting his pureed food despite previous tolerance 1 week after salicylic acid ingestion. An upper gastrointestinal (GI) tract series showed a shortsegment, high-grade stricture in his midthoracic oesophagus. Tolerance of oral intake progressively worsened, and he was re-admitted. Upper endoscopy revealed a stricture extending from 16–23cm from his mouth. He underwent balloon dilation, and he was able to tolerate pureed food the following day. However, vomiting recurred 1 week later, and dilation was repeated; on this occasion, he also experienced oesophageal perforation, and required surgery and placement of a gastrostomy tube. He was conservatively managed and discharged receiving nutrition via the gastrostomy tube 1 week later. He subsequently underwent 14 biweekly dilation procedures with serial steroid injections, achieving an oesophagus diameter of 15mm five months after salicylic acid intake. An infant boy accidentally ingested unknown quantities of a wart remover containing salicylic acid. Oral burns and lip burns were diagnosed at an emergency department, and he was discharged. However, he only tolerated liquids and pureed food, but no solids. He presented with persistent dysphagia at the age of 19 months, 6 months after salicylic acid ingestion. An upper GI tract series showed a 4–5cm oesophageal stricture starting at T3 [time to onset not clearly stated]. The stricture did not allow passage of an gastroscop
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