[Results of emergency management of esophageal lesions related to caustic ingestion in children in the emergency department of the General Reference Hospital of Niamey (Niger)]. / Résultats de la prise en charge médico-chirurgicale en urgence des lésions œsophagiennes liées aux ingestions de produits caustiques chez l'enfant dans le service des urgences de l'Hôpital général de référence de Niamey (Niger).

Introduction: Caustic ingestion in children is a public health problem; it is mainly due to domestic accidents due to improper packaging and storage of caustic products. It is a medical and surgical emergency whose management is multidisciplinary. The lesions caused by the accidental ingestion of caustics can affect the functional and vital prognosis in 10% of cases. Methodology: A retrospective, descriptive study from January 2020 to December 2022 (2 years), carried out in the emergency department of the General Reference Hospital of Niamey (Niger). The study included patients less than 15 years old admitted for ingesting a caustic product. Results: Our study included 17 patients. The average age was 5 years, with age extremes of 2 to 11 years. We noted a male predominance with a sex ratio (M/F) of 2.4. Ingestion of caustic products was accidental in all cases. The caustic product was caustic soda in 59%. The average quantity of product ingested was 5 ml (2 ml to 20 ml). The average consultation time was 3 days (3 hours to 15 days). Clinically, dysphagia was the most functional sign, represented by 13 cases, or 76%. Regarding general signs, 3 patients (18%) were admitted with fever; blood pressure was normal in 15 patients (88%); and 2 patients (18%) were admitted in a state of shock. The respiratory rate was normal in 14 patients (82%). Four patients (24%) were admitted in a state of deterioration in the general condition associated with severe malnutrition and dehydration. On physical examination, 2 patients (12%) presented with abdominal defense at the epigastric level. Examination of the ENT sphere revealed benign buccopharyngeal ulcerations in 2 patients (12%). Esogastroduodenal fibroscopy was performed in 4 patients (24%). The caustic lesions observed in the esophagus were: Zargar stage I at 25%, stage Ila at 50%, and stage Illb at 25%. In the stomach, the lesions were Zargar stage I in 75% of cases and stage III in 25% of cases. An injected thoracic-abdominopelvic computed tomography (CT) was performed in 3 patients (18%). It revealed a lack of enhancement of the esophageal wall compatible with esophageal necrosis in one patient. An esophagogastroduodenal transit was performed in 8 patients (47%) admitted more than 72 hours after ingestion of the caustic. They showed esophageal stenoses longer than 3 cm in 3 patients, multiple esophageal stenoses in 2 patients, a single esophageal stenosis in 2 patients, and a single antropyloric stenosis in 1 patient. Therapeutically, all patients benefited from antiemetics to avoid vomiting and proton pump inhibitors. Intravenous antibiotic prophylaxis with third-generation cephalosporin was administered to 12 patients (71%). Corticosteroid therapy based on IV prednisolone at a dose of 1 g/1.73 m2 per day was used to limit or prevent stenoses in 9 patients (53%). Parenteral nutrition was administered to 7 patients (41%). Endoscopic dilations were performed in 2 patients (12%). Emergency surgical treatment was performed in 7 patients (41%): 3 patients underwent transitional feeding gastrostomies; in 3 others, esophagoplasties by colon transplant were performed, and 1 patient was treated by stripping of the esophagus associated with total gastrectomy. The postoperative course was marked by a leak of esocolic anastomosis in one patient for whom conservative treatment was performed with good progress. The average length of hospital stay was 5 days (1-32 days). Conclusion: Accidental caustic ingestions can have serious consequences. Preventing these accidents relies on raising public awareness of the dangers associated with improper storage of these products.

Clinical evaluation and treatment outcomes of caustic ingestion injuries in Syrian pediatric patients: A retrospective study: Short title: High-dose steroids for pediatric caustic ingestions in Syria.

Introduction: Accidental ingestion of caustic agents poses a significant concern in pediatric emergency departments globally. It is a growing public health concern in low-to-middle income countries, which often lack comprehensive data reporting. This study examines high doses of corticosteroid treatment outcomes of caustic ingestion injuries in Syrian pediatric patients, addressing clinical features, and associated variables. Methods and materials: A retrospective observational study was conducted at University Pediatric Hospital from January 2016 to January 2019. Medical records were reviewed for patients aged <10 years with esophagoscopy-confirmed grade IIa, IIb, or III burns. Data collected included sociodemographics, esophagoscopy results, treatment details, and outcomes. Results: Among 114 pediatric patients, 76 (67%) were males and 38 (33%) were females. Age groups included <1 year (11%), 1-3 years (39%), 3-5 years (29%), 5-7 years (11%), and >7 years (11%). Alkaline burns accounted for 54% of injuries, acidic for 32%, and other substances for 13%. Complications included bleeding (19%) and psychomotor disability (7%). The most common burn site was the entire esophagus (62%), with 81% having grade II burns. Healing was achieved in 71% of patients with high doses of corticosteroids treatment, and 29% required dilation, with final 92% healing rate. Conclusion: The use of corticosteroids for esophageal strictures remains inconclusive, demanding further robust research with larger sample sizes and control groups. While our study revealed that high doses of corticosteroids treatment followed by esophageal dilation had a 92% success rate. However, our study demonstrates promising results, methodological limitations and absence of a control group underscore the need for more definitive evidence. Both alkali and acidic ingestion contribute to stricture development.

Epidemiologic features and outcomes associated with caustic ingestion among adults admitted in intensive care unit from 2013 to 2019: a French national observational study.

PURPOSE: Caustic ingestion is a potential life-threatening condition associated with high morbidity and mortality. Data on patients admitted to Intensive Care Unit (ICU) for severe caustic ingestion are lacking. We aimed to describing epidemiological features and outcomes of patients admitted to ICU for caustic ingestion in France. METHODS: In a retrospective, observational, and multicenter study, data from the national French Programme de Médicalisation des Systèmes d'Informations (PMSI) database were analysed from 2013 to 2019. In-hospital mortality rate (primary outcome) and in-ICU complications (secondary outcomes) were reported and analysed. RESULTS: 569 patients (289 males (50.8%), with median age of 49 years [interquartile (26-62)] were admitted in 65 French ICU for severe caustic ingestion. Five hundred and thirteen patients (90%) were admitted for intentional caustic ingestion. The median length of stay in ICU was 14.0 [4.0-31.0] days. In-hospital mortality occurred in 56 patients (9.8%). In multivariate analysis, age and simplified acute physiology score II were associated with in-hospital mortality age of 40-59 years [OR = 15.3 (2.0-115.3)], age of 60-79 years [OR = 23.6 (3.1-182.5)], and age > 80 years [OR = 37.0 (4.2-328.6)] and SAPS 2 score [OR = 1.0018 (1.003-1.033), p < 0.001]. During ICU stay, 423 complications (74%) were reported in 505 patients (89%). Infectious (244 (42.9%)), respiratory (207 (36.4%)), surgical 62 (10.9%), haemorrhagic (64 (11.2%)) and thrombo-embolic and (35 (6.2%)) complications were the most frequently reported during ICU stay. CONCLUSION: ICU admission for severe caustic ingestion is associated with 9.8% mortality and 74% complications. Age > 40 years and SAPS 2 score were independently associated with mortality.

Fatores associados a um maior número de dilatações esofágicas em crianças com história de ingestão alcalina / Factors associated with a higher number of esophageal dilations in children with a history of alkaline ingestion

ABSTRACT Background: Children who experience alkaline injury are at risk for the development of esophageal strictures and the need for esophageal dilations. Objective: We aimed to assess predictors for a higher number of esophageal dilatations in children following alkali ingestion. Methods: Single-center retrospective cohort study including children who underwent esophagogastroduodenoscopy (EGD) after alkali ingestion. Possible predictive factors for the need for esophageal dilatations were evaluated. Results: A total of 34 patients were included, and 19 were female (55.9%). The median age at the time of the accidents was 20.6 months (IQR 15-30.7). All alkali ingestions were accidental, in all cases involving liquid products, and most (24/34; 70%) occurred at the child's home. Homemade liquid soap was the agent in half of the cases. The most frequently reported symptom at presentation was vomiting (22/34, 64.7%). The median follow-up time was 3.2 years (IQR 1.1-7.4). On follow-up, the median number of esophageal dilatations required for these patients was 12.5 (IQR 0-34). Among demographic factors, male gender (P=0.04), ingestion of homemade products (P<0.01), and accidents happening outside of the household environment (P=0.02) were associated with a greater number of esophageal dilations on follow-up. An endoscopic classification Zargar of 2B or higher (P=0.03), the presence of stricture at the time of the second EGD (P=0.01), and gastroesophageal reflux disease (GERD) as a late complication (P=0.01) were also associated with a greater number of esophageal dilations on long term follow-up. Conclusion: Beyond the endoscopic classification severity - a well-known risk factor for the strictures after alkali ingestions, we found that male gender, accidents with homemade products, and accidents occurring outside the household environment were significantly associated with a greater number of esophageal dilatations in the long-term follow-up of children following alkali ingestion.

RESUMO Contexto: Crianças que sofrem lesões cáusticas correm alto risco de desenvolver estenose esofágica e necessidade de dilatações esofágicas. Objetivo: Objetivamos avaliar preditores de necessidade de maior número de dilatações esofágicas em crianças, após uma ingestão cáustica. Métodos: Estudo de coorte retrospectivo de centro único incluindo crianças submetidas a esofagogastroduodenoscopia (EGD) após ingestão cáustica. Foram avaliados possíveis fatores preditivos para a necessidade de dilatações esofágicas. Resultados: Foram incluídos 34 pacientes, 19 do sexo feminino (55,9%). A idade mediana no momento dos acidentes foi de 20,6 meses (IQR 15-30,7). Todas as ingestões cáusticas foram incidentais, de substâncias líquidas, e a maioria dos acidentes (24/34; 70%) ocorreu no domicílio da criança. Em metade dos casos, a substância ingerida foi um sabão caseiro. O sintoma mais reportado na apresentação foi vômito (22/34 -64,7%). O tempo médio de acompanhamento foi de 3,2 anos (IQR 1,1- 7,4). No seguimento, o número médio de dilatações esofágicas necessárias foi de 12,5 (IQR 0-34). Entre os fatores demográficos, o sexo masculino (P=0,04), acidentes com produtos caseiros (P=<0,01) e a localização do acidente fora do ambiente domiciliar (P=0,02) foram associados a um maior número de dilatações esofágicas no seguimento. A classificação endoscópica Zargar 2B ou mais (P=0,03), a presença de estenose na segunda EGD (P=0,01) e a DRGE como complicação tardia (P=0,01) também se associaram a maior número de dilatações esofágicas no acompanhamento a longo prazo. Conclusão: Além da gravidade da classificação endoscópica - fator de risco bem conhecido para as estenoses após ingestão de cáusticos, observamos que o sexo masculino, os acidentes com produtos caseiros e os acidentes ocorridos fora do ambiente doméstico foram fatores significativamente associados a um maior número de dilatações esofágicas em acompanhamento em longo prazo de crianças após ingestão de soda cáustica.

Hepatic Portal Venous Gas (HPVG) after Ingestion of Chlorine Bleach: A Transient Phenomenon.

We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association between chlorine bleach ingestion and the development of hepatic portal venous gas (HPVG), a radiological finding traditionally thought to carry poor prognoses. The HPVG in this case resolved spontaneously within 24 h with conservative management, indicating its transient nature. The exact pathophysiological mechanisms responsible for HPVG after the ingestion of toxic substances .remain only partially understood. One hypothesis suggests that extensive damage to the gastrointestinal wall caused by caustic agent may allow enteric gas to enter the portal system. While HPVG after toxic ingestion is often transient, its consequences and potential risks should be carefully considered. Hyperbaric oxygen therapy is suggested in cases with neurological symptoms. In conclusion, HPVG is not a specific disease but rather a manifestation of various underlying factors, and its development in the context of chlorine bleach ingestion represents an additional insight to its understanding. It can be associated with severe medical conditions, but it is also found in less severe cases that can be managed conservatively.

Ingesta de cáusticos en niños, experiencia de 3 años / Ingestion of caustic substances in children: 3 years of experience

Introdución: La ingesta accidental de cáusticos en pediatría no dispone de un consenso claro de actuación. El objetivo de este estudio fue caracterizar la población pediátrica atendida por ingesta de cáusticos en un centro asistencial. Pacientes y método: Estudio descriptivo de los pacientes atendidos en nuestro hospital por la ingesta de cáusticos durante el período 2008-2011. Resultados: Se atendieron 12 pacientes, edad media de 3,8 años (1-13 años). Predominio de varones (58,8%). Un 58,3% ingirió producto alcalino y un 41,6% ácido. El 58,3% no refería sintomatología, el resto refirió vómitos (33,3%), odinofagia (16,6%), hematemesis (8,3%), sialorrea (8,3%) y dificultad respiratoria (8,3%). El 75% presentaron lesiones en la cavidad oral. Todos, salvo un caso, fueron accidentales. Se realizó endoscopia al 100% entre las 12 y 24 h postingesta con hallazgos patológicos en un 41,6%. En el grupo ingesta de álcalis 2 pacientes presentaron lesiones (16,6%): una esofagitis grado 2B y una grado 3. En el grupo ingesta de ácidos 4 pacientes (33,3%) presentaron lesiones: una esofagitis aguda grado 1-2A, 2 gastritis agudas no erosivas y una gastritis aguda hemorrágica. Se realizó endoscopia de control según los hallazgos endoscópicos previos. Solo 2 presentaron complicaciones posteriores. Conclusiones: Destacamos la valoración endoscópica en las primeras 24 h en todas las ingestas sintomáticas y deliberadas, así como la reevaluación estrecha en las ingestas ácidas, por asociar lesiones diferidas.

Introduction: There is no clear consensus on the management of accidental ingestion of caustic substances in paediatrics. The aim of this study was to determine the profile of the paediatric population treated due to caustic ingestion in a Healthcare Centre. Patients and method: A descriptive study was conducted on patients treated for the ingestion of caustic substances in our hospital during the period 2008-2011. Results: A total of 12 patients were treated, with a mean age of 3.8 years (1-13 years), with the majority males (58.8%). An alkaline product was ingested by 58.3%, and an acid by 41.6%. The majority (58.3%) did not refer to symptoms and the remainder referred to vomiting (33.3%), odynophagia (16.6%), haematemesis (8.3%), hyper-salivation (8.3%) and shortness of breath (8.3%). Oral cavity lesions were observed in 75% of cases. All, except one, were accidental. An endoscopy was performed on all of them (100%) between 12 and 24 hours post-ingestion, with pathological findings in 41.6%. In the group that ingested an alkali, 2 (16.6%) patients had lesions, one a grade 2B and one a grade 3 oesophagitis. In the acid ingestion group, 4 (33.3%) patients had lesions; one grade 1-2A oesophagitis, two acute non-erosive gastritis, and one acute haemorrhagic gastritis. A follow-up endoscopy was performed depending on the previous endoscopic findings. Only two patients presented with complications. Conclusions: Emphasis is placed on the endoscopic evaluation in the first 24 hours of deliberate asymptomatic ingestions, as well as a strict follow-up in those that ingested acids, due to delayed associated lesions.

Estenosis esofágica por ingestión de cáusticos / Esophageal stenosis due to caustic ingestion

RESUMEN Las sustancias químicas son causas importantes de lesiones del tracto gastrointestinal y suelen afectar dos grupos de pacientes: los niños menores de 5 años y los adultos que intentan el suicidio. La principal complicación de la ingesta accidental de cáusticos es la estenosis esofágica. Diferentes formas de tratamiento se han aplicado para tratar las estenosis esofágicas por cáusticos y en primera línea está la dilatación endoscópica, con resultados exitosos en el 60 a 80% de los pacientes. Si estas no son efectivas, se indica el tratamiento quirúrgico de reemplazo esofágico, y entre las técnicas más frecuentes destaca la esofagectomía de dos vías de Ivor Lewis y la esofagectomía transhiatal. Se presenta el caso de un paciente del sexo masculino de 20 años de edad que consultó en el Departamento de Cirugía por cuadro de dificultad para la deglución, con el antecedente de ingestión accidental de soda caústica 2 meses antes. Con estudios imagenológicos y endoscópicos se confirmó el diagnóstico de estenosis esofágica por ingestión de cáusticos. Se le realizó una esofagectomía transhiatal asociado a una yeyunostomía de alimentación. La complicación presentada fue neumotórax bilateral en post operatorio, el cualfue resuelto con tubo de drenaje pleural sellado bajo agua. Se indicó el alta hospitalaria en su 15 día de postoperatorio, con buena tolerancia oral.

ABSTRACT Chemicals are important causes of gastrointestinal tract lesions and usually involve two groups of patients: children under 5 years and adults who attempt suicide. The main complication of accidental ingestion is caustic esophageal stricture. Different forms of treatment have been used to treat esophageal stricture and on the frontline is the endoscopic dilation, with successful results in 60 to 80% of patients. If these are not effective, surgical treatment is indicated with esophageal replacement and the most common techniques are the two-way Ivor Lewis esophagectomy and transhiatal esophagectomy. We present a case of a male patient, aged 20 years, consulting in the Department of Surgery with difficulty to swallowing, with a history of accidental ingestion of caustic soda 2 months before. Imaging and endoscopic studies confirmed the diagnosis of esophageal stenosis of caustic ingestion. He underwent a transhiatal esophagectomy associated with a feeding jejunostomy. The complication was bilateral pneumothorax presented in the postoparative time, which was resolved with pleural drainage tube sealed under water. He was discharged from hospital in 15 days after surgery, with good oral tolerance.

La ingestión de cáusticos en el niño: un problema de salud pública / The caustic ingestion in children: a public health problem

La ingestión de cáusticos en la edad pediátrica es un problema grave al producir una lesión progresiva y devastadora en el esófago y el estómago. Estudio retrospectivo y descriptivo de 421 pacientes en edades comprendidas de 2 meses a 14 años quienes ingirieron cáusticos entre 1.992 y 2.008, evaluados en el Hospital Universitario de Maracaibo. El 60,09% eran pre-escolares y el 62,23% eran del sexo masculino. La sustancia tipo álcali fue ingerida en el 90,73% de los casos y los cáusticos se encontraban almacenados en su envase original en 3,8% y trasegados en el 96,2% de los casos. La ingestión fue de origen accidental en el 99,53%. Todos los pacientes manifestaron alguna sintomatología como lesiones orofaríngeas, vómitos y sialorrea. La evaluación endoscópica se realizó en el 89,31% de los casos y se evidenció lesiones en el tracto gastrointestinal en 60,63%. Los pacientes con Esofagitis Grado III y estenosis esofágica fueron incluidos en el programa de dilatación, con una buena evolución en el 35,91% de ellos. La ingestión de cáusticos constituye un problema frecuente y serio, en su mayoría de origen accidental, afecta principalmente a menores de 6 años y el álcali es el principal agente involucrado. La Endoscopia Digestiva es el estudio por excelencia para evaluar estos pacientes. Las dilataciones esofágicas son moderadamente exitosas. El mejor tratamiento es la prevención.

The caustic ingestion in the pediatric population is a serious problem because produce a progressive and devastating injury to the esophagus and stomach. Retrospective and descriptive study of 421 patients with age from 2 months to 14 years who ingested caustic between 1.992 to 2.008 evaluated at the Hospital Universitario de Maracaibo. The 60.09% were pre-school and 62.23% were male. The substance type alkali was swallowed by 90.73% of cases and the caustics were stored in its original packaging by 3.8% and decanted in 96.2% of cases. Intake was accidental source in 99.53%. All patients showed some symptoms as oropharyngeal lesions, vomiting and drooling. Endoscopy evaluation was performed by 89.31% of cases and revealed gastrointestinal tract injuries in 60.63%. Patients with grade 3 Esophagitis and esophageal stricture were admitted in the dilatation program with a good success in 35.91% of them. The caustic ingestion is a common and serious problem, mostly from accidental origin, mainly affects children under 6 years and the alkali is the principal agent involved. The Esophagoscopy is the ideal mean for evaluate these patients. The esophageal dilatations are moderately successful. The best treatment is the prevention.

Estudo morfológico macro e microscópico da gastrite cáustica em ratos / Macro and microscopic morphology of caustic gastritis in rats

OBJETIVOS: A ingestão de álcalis provoca graves lesões no tubo digestório alto. A comercialização de substâncias cáusticas em forma líquida facilita o seu uso com intenções suicidas e torna as afecções por elas provocadas relativamente comuns. Nesse sentido, o objetivo do presente trabalho foi avaliar as conseqüências morfológicas da infusão de substância cáustica no estômago murino. MÉTODO: Foram estudados 20 ratos Wistar adultos, de ambos os sexos. Após jejum alimentar de 12 horas, instilou-se 1ml de hidróxido de sódio (NaOH) a 5 por cento através de cateter orogástrico. Os ratos foram divididos aleatoriamente em quatro grupos (n=5), de acordo com o tempo de acompanhamento: 24 horas, sete dias, 30 dias e 90 dias, respectivamente. Decorrido o tempo de acompanhamento, os ratos foram mortos e seus estômagos foram avaliados macro e microscopicamente. RESULTADOS: Após 24 horas, os estômagos estavam dilatados e com aderências ao fígado, omentos e pâncreas. Suas mucosa e submucosa apresentavam áreas de necrose de coagulação do corpo e do antro entremeada por intensa infiltração bacteriana. Após sete dias, os estômagos permaneciam dilatados e mantendo o mesmo padrão necrótico anterior, porém sem os focos sépticos. Nos grupos de um e três meses, a cavidade abdominal teve aspecto normal. Os estômagos apresentavam consistência endurecida e com proliferação fibrovascular. CONCLUSÃO: Os animais que sobreviveram à necrose e à intensa infiltração bacteriana da primeira semana desenvolveram reparação progressiva de seus estômagos, porém acompanhada de complicações decorrentes da fibrose cicatricial.

BACKGROUND: Alkali ingestion causes severe injuries in the upper gastrointestinal tract. Currently, a large variety of these agents may be found in liquid form, increasing their use in suicide attempts and accidental ingestion. The goal of the present study was to evaluate morphological effects of alkali ingestion in murine stomach. METHOD: Twenty adult rats, of both sexes were submitted to NaOH-5 percent gastric infusion through an orogastric catheter. Rats were randomly divided into four groups (n = 5), and studied after 24 hours, 7 days, 30 days and 90 days, respectively. The animals were killed and their stomach and abdominal cavity were assessed. RESULTS: After 24 hours, mucosa and submucosa presented coagulation necrosis, with a mild acute transmural inflammation with polymorphonuclear infiltration and numerous necrotic focci. After 7 days, the necrotic aspect was the same, but with no necrosis. In the groups of 30 and 90 days the abdominal cavity recovered its normal aspect. Stomachs showed fibrosis, rigidity and fibrovascular proliferation. CONCLUSION: The rats that survived to necrosis and bacterial infiltration during the first weeks, developed progressive healing of their stomachs, maintaining the risk of complications due to intense fibrosis.