Ingestions de caustiques chez l'enfant à Brazzaville, Congo

Contexte et objectif. Les ingestions de caustiques chez l?enfant sont préoccupantes en raison de l?augmentation de leur fréquence et des difficultés inhérentes à leur prise en charge. L?objectif du présent travail était de décrire le profil clinique, épidémiologique et évolutif des enfants avec lésions caustiques.Méthodes. Il s?est agi d?une étude transversale, réalisée entre les 1er janvier 2014 et 31 décembre 2015, dans les services de Pédiatrie du CHU et les centres d?endoscopie digestive de Brazzaville. Tous les enfants ayant ingéré un produit caustique et hospitalisé pendant la période d?étude ont été inclus après l?obtention du consentement du parent et/ou tuteur légal. Les paramètres étudiés ont été : l?âge, le sexe, la nature et la quantité du produit ingéré, l?attitude de l?entourage de l?intoxiqué, les signes cliniques, les résultats endoscopiques selon la classification de Zargar, les modalités thérapeutiques et évolutives.Résultats. Sur 8292 enfants hospitalisés pendant la période étudiée, 68 avaient ingéré un caustique, soit une fréquence hospitalière de 0,8 %. Leur âge moyen était de 23,6 mois (extrêmes de 2 mois et 16 ans). Le sexe masculin était prédominant (57,4%). L?ingestion était accidentelle dans 88,2% des cas et volontaire dans 11,8% des cas. Les facteurs favorisants l?ingestion étaient fréquemment le mode de stockage du caustique (81,5%) et l?inattention ou négligence du tuteur (10,8%). L?eau de Javel était le caustique le plus incriminé : 37 cas (54,4%), suivi de la soude caustique 20 cas (29,4%). La quantité estimative ingérée était supposée minime dans 61,7% des cas. Des gestes inadaptés ont été pratiqués, par l?entourage avant la consultation médicale chez 45 enfants (66,1%). Les symptômes dominants étaient digestifs (47%) ou neurologiques (25%). Le délai moyen de réalisation de l?endoscopie était de 48 heures chez 60 enfants (88,2%). L?endoscopie avait mise en évidence des lésions dans 51,7% des cas au stade I (12 cas), stade II (16 cas) et stade III (3 cas). Les facteurs de gravité des lésions caustiques étaient les gestes inadéquats dans 85% des cas et le non-respect du jeûne dans 9%. Les Inhibiteurs de la pompe à protons (IPP) étaient administrés dans 50% des cas. L?évolution était favorable dans 73,5% des cas.Conclusion. Les lésions caustiques rendent compte de près d?un percent d?admissions infantiles hospitalières. Elles sont le plus souvent accidentelles, favorisées par le mode de conditionnement des produits caustiques dans des flacons d?eau minérale et stockés dans des endroits non appropriés. La prévention consiste à l?éducation des populations pour éviter la survenue de ces accidents

Caustic soda ingestion in children under-5 years presenting for fluoroscopic examinations in an Academic Hospital in Ghana.

BACKGROUND: Disastrous effects and lifelong complications, ranging from respiratory and gastrointestinal burns to death can result from caustic soda ingestion. Accidental and non-accidental ingestions occur in different age groups. However, it is very troubling to find ingestion of caustic soda a very common occurrence among children below 5 years since they do not have the developmental level required to independently weigh up risks and are also under parental and societal protections. This study was therefore planned to investigate the ingestions of caustic soda by these children for purposes of proposing measures to curb the problem. METHODS: Descriptive survey was employed for this study. A 14-item, semi-structure questionnaire was purposively issued to 57 parents/guardians whose wards had ingested caustic soda. Data was analysed with SPSS V.20. RESULTS: Twenty-seven (47.4 %) children got access to the soda at storage, 1 (1.86 %) was administered accidentally by a sibling while 29 (50.9 %) ingested during soap preparation. In respect of the former, the majority got access because it was stored in soft drink and water bottles in their parents/guardians rooms or kitchen. For the later, the children got access to the left-over soda because the soap-makers failed to adhere to good storage and disposal practices. CONCLUSION: Storage of caustic soda in soft drink and water bottles in accessible places, and training of children to drink directly from bottles influence caustic soda ingestion in children under five. Non-compliance to good practices of storage and disposal of caustic soda during soap preparation increases exposure and access of children to caustic soda ingestion.

[Conservative treatment improved corrosive esophagitis and pneumomediastinum in a patient who ingested bleaching agent containing sodium hypochlorite and sodium hydroxide].

A 69-year-old man was admitted to the emergency department 3 hours after ingestion of a bleaching agent containing hypochlorous acid and sodium hydroxide in a suicide attempt. Enhanced chest computed tomography scans taken on admission indicated an edematous esophagus and air bubbles in the mediastinum. He underwent endotracheal intubation and mechanical ventilation until day 9 because of laryngeal edema. On day 10, his endoscopy indicated diffuse reddish mucosal hyperemia, erosions, and lacerated mucosal lesions in the esophagus that were indicative of grade 2b corrosive esophagitis. Treatment with a proton pump inhibitor was initiated, with which the condition of the esophagus improved, and on day 44, a slight stricture of the upper part of the esophagus was observed. He was discharged on day 64 without any complaints. The ingestion of sodium hypochlorite induces corrosive esophagitis and acute phase of gastritis. Ingestion of any corrosive agent is known as a risk factor for esophagus cancer in the long-term. In such cases with esophageal stricture, esophagectomy is recommended for preventing esophagus cancer. Considering the age of the patient, however, he did not undergo esophagectomy.

Right colon interposition in corrosive esophageal long segment stricture: our local experience.

BACKGROUND: Aim of our study is to highlight technical details in pedicled right colon interposition locally in cases of long segment corrosive esophageal stricture. Lesion results from cicatrization of burns wound inflicted by chemicals. Restoration of swallowing is of paramount importance. MATERIALS AND METHODS: It was a retrospective study involving adult and adolescent patients who had surgery because of corrosive esophageal stricture between January 2001 and December 2010. Hospital records were reviewed for age, sex, radiological findings, detail of anesthesia, operative procedure, and follow up. The steps which included mobilization of colon with intact marginal blood supply, safeguarding the middle colic artery that forms the pedicle, and doing three anastomoses that were leak proof were ascertained. RESULT: There were 12 males (70.5%) and six females (29.4%) and age ranged from 14 to 45 years. Caustic soda caused the problem among 10 (58.8%) patients while liquid acid battery was involved in three (17.6%) patients. The rest were distributed equally between native concoction and unknown substance. All were done under general anesthesia and mean duration of the procedure was 306.8 ± 54.6 min with an average intra operative blood loss of 823.1 ± 428.5 m. Sixteen (94.1%) had successful pedicle isolation and 15 (82.3%) patients had neither dysphagia nor reflux at follow-up. CONCLUSION: Securing a pedicled right colon based on middle colic artery was a critical step. This surgical technique should be used to restore swallowing among patients with long segment esophageal stricture.

[Acute oral double intoxication with caustic substance--a case report]. / Dwukrotne doustne zatrucie substancja zraca--opis przypadku.

Acute oral caustic ingestion may cause serious multiorgan failure. We described a case of patient who ingested twice large amount of liquid sodium hydroxide as a suicidal attempt. According to our knowledge this is the first case report of acute oral double intoxication with caustic substance in the medical literature. Late sequela (as esophagus stricture) after caustic ingestion may lead to extreme cachexia in spite of endoscopic and surgical treatment. Dual caustic ingestion obstructs the diagnostic and treatment and worsens patient's prognosis.

Corrosive poisoning mimicking cicatricial pemphigoid: Munchausen by proxy.

BACKGROUND: Munchausen by proxy (MBP) is a severe form of abuse in which a caregiver simulates or fabricates illness in another person, primarily the elderly and children, which can even result in death. CASE: We report two siblings who were victims of MBP, one of whom died. A very rare diagnosis, cicatricial pemphigoid was suspected in the 2-year-old girl who was first abused. She was hospitalized twice, for 3 and 4 months, respectively. Her second hospitalization ended with her death. MBP was diagnosed after the second sibling's admission with similar atypical signs and symptoms. It was realized that a household-cleaning product, sodium hydroxide, was administered repeatedly by oral route to the children by their own mother. CONCLUSIONS: Physicians must consider the diagnosis of MBP whenever they are confronted with unusual, persistent or recurrent signs and symptoms in a child.

The oral implications of caustic soda ingestion in children.

The morbidity related to caustic soda (sodium hydroxide) ingestion is well described in the literature. The majority of publications have concentrated on the effects to the trachea and gastrointestinal tract, with little reference to the oral and peri-oral areas. Accidental ingestion of sodium hydroxide-containing substances is fortunately rare; however the consequences can be devastating. Three cases of children who drank caustic substances are described. Treatment included fitting splints, injecting steroids, local surgical procedures, and the use of dynamic appliances to maintain mouth opening. Despite these interventions, all patients developed severe scarring, resulting in stenosis of the oral musculature and extra-articular ankylosis. There is perhaps a role for further investigation of early use of antiproliferative agents to prevent scarring, more aggressive surgery, and long-term physiotherapy appliance use. These patients require lifelong follow-up.

Detection of tracheoesophageal fistula caused by ingestion of a caustic substance by esophageal scintigraphy.

A 4-year-old boy was referred for scintigraphic evaluation of esophageal transit 24 hours after he had ingested sodium hydroxide. After oral administration of Tc-99m sulfur colloid, scintigraphy showed marked and prolonged retention of the radioactive bolus in the middle and lower thirds of the esophagus. Three weeks after ingestion of the caustic substance, repeat scintigraphy was requested to evaluate esophageal transit and gastric-emptying. In this presentation, a tracheoesophageal fistula was a consequence of sodium hydroxide ingestion and was identified with radionuclide scintigraphy before there was clinical and radiologic detection.

Epidemiología por ingestión de cáustico de niños / Epidemiology of caustic ingestion by children

Un total de 743 niños menores de 14 años fueron estudiados por sospecha de ingestión de cáustico durante un periodo de 10 años. El 20.32 por ciento presentaron lesiones cáusticas, 88 de primer grado, 23 de 2° y 20 de 3°. Todos los pacientes con lesión de 2° y/o 3° grado recibieron tratamiento con esteroides y antibióticos. No existen diferencias estadísticas en la distribución anual, mensual ni semanal de las ingestiones. El 53.16 por ciento eran procedentes del medio urbano. El 84.92 por ciento de los niños eran menores de 3 años, con una edad media de 27.05 meses y una relación varon/mujer de 2/1. Todas las ingestiones fueron accidentales. La lejía fue ingerida en el 73.3 por ciento de los casos. Los agentes que mas causticaciones han causado fueron los lavavajillas industriales (59.09 por ciento), la sosa y los desatascadores (54.54 por ciento). Existe una relación de los alcalinos sobre los ácidos de 11/1. El hogar es el lugar mas frecuente de accidentes (58.27 por ciento) y dentro de el la cocina (48.3 por ciento). El cáustico, se encontraba fuera del envase original en el 74.8 por ciento de las ingestiones. No encontramos relación alguna entre la presencia o no de sintomatología o datos exploratorios positivos con el posterior hallazgo de lesiones esofágicas. 39 pacientes desarrollaron estenosis esofágica, de las que 21 requirieron tratamiento con dilatación esofágica. Creemos que la estrategia de una prevención a todos los niveles desde una fabricación de seguridad, normas de educación sanitaria, campañas de información especifica y directa así como envasado ideal: inviolable, económico y con poca cantidad de cáustico, es fundamental para la reducción de este tipo de accidentes (AU)

Alkaline esophagitis evaluated by endoscopic ultrasound.

CASE REPORT: Two patients with corrosive esophagitis caused by alkaline household agents were examined with endoscopic ultrasound using a 20-MHz probe. In the first case, endoscopic ultrasound revealed circumferentially thickened mucosa and muscularis propria, and lack of differentiation between the mucosa and submucosa. However, esophageal stricture did not develop during 3 months of follow-up, suggesting that the deep lesion may have involved a narrow section of esophagus only. In the second case, a markedly thickened mucosa was seen, resulting in no sequelae. Endoscopic ultrasound offers a more accurate evaluation of the depth of the lesions in alkaline esophagitis compared to standard endoscopy or computed tomography. Longitudinal studies are needed to identify lesions at greatest risk for progression to stricture.

Incidência e diagnóstico da ingestäo de cáustico / Incidence and diagnosis of caustic ingestion

Objetivos: O presente estudo procura identificar a configuraçäo dos pacientes que ingeriram cáustico, de acordo com as variáveis sócio-demográficas, os motivos da ingestäo, a sintomatologia e o diagnóstico. Material e método: A coleta de dados foi feita através dos prontuários de 239 pacientes que ingeriram "soda cáustica". Resultados: Os resultados revelaram que a taxa de incidência de casos atendidos no hospital escoIa foi de 0,5/100.000 habitantes, havendo uma reduçäo de casos na década de 90. As pessoas do sexo feminino foram as o que mais ingeriram cáusticos, 56,9 por cent0 (153) e, quanto aos motivos de ingestäo, 59,8 por cento dos casos foram por tentativa de suicídio e 37,2 por cento, de forma acidental; havendo uma tendência para a diminuiçäo de ingestöes por tentativa de suicídio, na última década. A quantidade de cáustico ingerida variou de "fragmentos" até três colheres de sopa, sendo que entre os suicidas a quantidade tende a ser maior. Conclusäo: Os sintomas apresentados foram dor e vômito, além de sialorréia, disfagia, náuseas e lesöes na cavidade oral. A utilizaçäo dos sinais e sintomas, bem como a quantidade de "soda cáustica" sólida ingerida, parecem ser importantes indicadores do prognóstico e da evoluçäo das lesöes cáusticas. A esofagoscopia determina a severidade das queimaduras, estabelece o tipo de terapêutica a ser usada e estima o prognóstico e o tempo de internaçäo, nos casos de ingestäo de quantidades desconhecidas. O diagnóstico das complicaçöes se faz pelo estudo radiológico, incluindo tomografias, esofagoscopia, gastroscopia e exames laboratoriais

Ingestión de pilas y baterías: manejo en pacientes pediátricos / Ingestion of alkaline batteries: management of pediatric patients

La ingestión de cuerpos extraños es común durante la infancia. En los últimos años el hombre ha creado una amplia variedad de artículos operados por pilas de disco o minibaterías, las que en general, son fáciles de remover y, por lo tanto, accesibles al niño que accidentalmente o por curiosidad puede ingerirla. La ingestión de baterías se ha constituido en un problema de salud de elevada morbilidad. Así por ejemple en USA se informa cada año un número superior a 2.500 ingestiones, las que se incrementan anualmente en un 25 por ciento, ocurriendo el 90 por ciento en menores de 5 años con predominio leve del sexo masculino

Esophageal motility in patients with esophageal caustic injury.

OBJECTIVE: There are few studies of esophageal function subsequent to the ingestion of lye. We investigated the esophageal motility of patients who had ingested liquid sodium hydroxide. METHODS: Esophageal manometry was performed on 21 patients who [1-53 yr before the manometric examination (median: 13 yr)] had drunk 10-30 g of sodium hydroxide diluted in water. The results were compared with those obtained for a control group of 22 healthy volunteers. RESULTS: The lower esophageal sphincter (LES) pressure of the caustic group (14.9 +/- 1.7 mm Hg, mean +/- SE) did not differ (p > 0.05) from that of the control group (17.4 +/- 1.1 mm Hg). LES pressure in eight patients was below 10 mm Hg. The amplitude of contraction was lower (p < 0.01) in the caustic group than in the control group. In the proximal part of the esophageal body, the duration of contraction was longer (p < 0.01) in the caustic group (2.3 +/- 0.1 s) than in controls (1.8 +/- 0.1 s). Nonperistaltic contraction was a finding in 14 patients, repetitive in five of them. The velocity of peristaltic contractions was higher (p < 0.05) in the caustic group (distal: 3.2 +/- 0.2 cm/s) than in the control group (2.2 +/- 0.2 cm/s). Although there was some impairment of esophageal motor function in 71% of the patients, they were asymptomatic when we performed esophageal manometry. CONCLUSIONS: Esophageal motility impairment was present in most of the patients who ingested sodium hydroxide. Nonperistaltic contractions of low amplitude were found most frequently.

[Sternotomy for the treatment of cervical stenosis after esophagocoloplasty: 3 case reports]. / Esternotomia para o tratamento da estenose cervical após esofagocoloplastia: relato de três casos.

Colon interposition for benign esophageal disease has so many complications among them stricture and anastomotic leak are the most common. Three patients with esphagocolonic stricture due to colon interposition have been successfully treated by sternotomy after being submitted to endoscopic balloon dilatation. Sternotomy would seen a safe and reliable method for treating anastomotic stricture in patients with recurrent stenosis after esophagocolonic anastomosis due to extrinsic compression.