Orapich Kayunkid, MD, Panot Yimchareon, MD, Vibul Trakulhun, MD. Department of Surgery Bhumibol Adulyadej Hospital, Bangkok, Thailand
BACKGROUND: The ingestion of caustic substances is a common condition which may result in serious injury of the upper gastrointestinal system. Esophagogastroduodenoscopy (EGD) is the gold standard of assessing depth, extent of injury.
OBJECTIVE: The purpose of this study to determine the main caustic substance ingested and the lesion on the esophageal mucosa from EGD within 24 hours after injury. Find out incidence of esophageal stricture of these patients and long term follow up after management at our hospital.
DESIGN: Caustic agent ingestion patients at our hospital were studied. Reasons for ingestion, symptoms, physical findings, endoscopic findings, operative findings and procedures were reviewed from medical record of patients. Nearly all patients were performed esophagogram at 6 weeks after ingestion and long term follow up at least 6 years. Data were analyzed by using the descriptive statistical method.
RESULTS: From July 2004 – July 2011, 131 patients (81 female, 50 male) who ingested a caustic agent, had mean age 27.6+ 10.63 years. The caustic substance ingested were 15% hydrochloric acid 110 patients (84%) , sodium hydroxide 5 patients (3.8%) , caustic soda 1 patient and undetermined agent 15 patients .The mean volume of caustic substance was 36.2 + 18.3 ml . The reasons for ingestion were a family conflict 83 patients ( 63.4%) , study problem 20 patients (15.2%) work and business problem 15 patients (11.5%) , accident 7 patients (5.3 %) , psychiatric problems 6 patients (4.6%) . The signs and symptoms of these patients when they were admitted into our hospital were oropharyngeal burn 57.5%, drooling 52.5% , dysphagia 32.3% chest pain 16.6% , epigastrium pain 70.8% , stridor 2.5% and diarrhea 0.83% . 125 of 131 underwent endoscopy and lesions found were normal 11 patients, grade I 42 patients , grade II 60 patients and grade III 12 patients and 8 of 131 went to surgery because of peritonitis and mediastinitis. The others who did not show sign of peritonitis were treated by conservatively. The mean follow-up period was 77.3+6.6 months. During this period, esophageal strictures were developed 14.2 % in 2nd degree burn and 100 % in 3rd degree burn patient. Fifteen patients of 2nd and 3rd degree burn underwent endoscopic dilation but only 7 patients were successful and other underwent surgery.
CONCLUSIONS: Hydrochloric acid is the most frequently ingested caustic substance. Family conflicts are the most frequent stated reason for caustic ingestion. Clinical symptoms are variety. Clinical symptom of dysphagia and early endoscopic evaluation may predict morbidity outcomes .No esophageal strictures developed in first degree burn patients. Second degree burn patients should be followed up by esophagogram at 6 weeks after ingestion or when dysphagia occurred for early detection of esophageal stricture complication.
Session Number: Poster – Poster Presentations
Program Number: P218