Kaan DEMİRÖREN, Halil KOCAMAZ, Yaşar DOĞAN

Gastrointestinal system lesions in children due to the ingestion of alkali and acid corrosive substances

To examine esophageal and gastric lesions in children due to the ingestion of alkali and acid corrosive substances and to emphasize all related complications. Materials and methods: The reports of 103 children who ingested or were suspected to have ingested corrosive substances and who then underwent upper gastrointestinal endoscopic inspections were evaluated retrospectively. Results: Of the patients, the mean age was 41 ± 3.6 months, and 57.3% were male. Vomiting was the most common symptom (44.7%). Eighteen different commercial products were defined as corrosive substances: 59.2% of them were alkali, 39.8% were acids, and 1% had a neutral pH. These corrosive agents most frequently contained sodium hydroxide, followed by hydrochloric acid, sodium hypochlorite, and sulfuric acid. Endoscopic inspections were abnormal in 68% of the cases. Esophageal lesions were observed in 56.3% of the patients, while gastric lesions were observed in 35%. During the follow-up period, esophageal strictures developed in 4.9% of patients, while gastric outlet obstructions developed in 1%. Conclusion: Of the patients, the mean age was 41 ± 3.6 months, and 57.3% were male. Vomiting was the most common symptom (44.7%). Eighteen different commercial products were defined as corrosive substances: 59.2% of them were alkali, 39.8% were acids, and 1% had a neutral pH. These corrosive agents most frequently contained sodium hydroxide, followed by hydrochloric acid, sodium hypochlorite, and sulfuric acid. Endoscopic inspections were abnormal in 68% of the cases. Esophageal lesions were observed in 56.3% of the patients, while gastric lesions were observed in 35%. During the follow-up period, esophageal strictures developed in 4.9% of patients, while gastric outlet obstructions developed in 1%.

Anahtar Kelimeler:

Corrosive substance, endoscopic inspection, esophageal stricture, gastric outlet obstruction

Gastrointestinal system lesions in children due to the ingestion of alkali and acid corrosive substances

Keywords:

Corrosive substance, endoscopic inspection, esophageal stricture, gastric outlet obstruction,

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Güven A. Çocukları evde bekleyen tehlike: Korozif özofagus yanıkları. TAF Prev Med Bull 2008; 7: 535–540 (in Turkish).
Tatar G, Ersoy O. Özefagusun acil patolojileri: koroziv madde alımı, yabancı cisimler, özefagus perforasyonu. Turk Klin J Surg Med Sci 2006; 2: 1–8 (in Turkish).
Johnson TB, Cassidy DD. Unintentional ingestion of potassium permanganate. Pediatr Emerg Care 2004; 20: 185–187.
Gershman G, Ament M. Practical Pediatric Gastrointestinal Endoscopy. Malden, MA, USA: Blackwell Publishing; 2007.
Janousek P, Kabelka Z, Rygl M, Lesný P, Grabec P, Fajstavr J, Jurovcík M, Snajdauf J. Corrosive injury of the oesophagus in children. Int J Pediatr Otorhinolaryngol 2006; 70: 1103–1107.
Kaya M, Özdemir T, Sayan A, Arıkan A. Koroziv madde içen çocuklarda klinik bulgular ile özofagus yaralanma şiddeti arasındaki ilişki. Ulus Travma Acil Cerrahi Derg 2010; 16: 537–540 (in Turkish).
Gupta SK, Croffie JM, Fitzgerald JF. Is
esophagogastroduodenoscopy necessary in all caustic ingestions? J Pediatr Gastroenterol Nutr 2001; 32: 50–53.
Gaudreault P, Parent M, McGuigan MA, Chicoine L, Lovejoy FH Jr. Predictability of esophageal injury from signs and symptoms: a study of caustic ingestion in 378 children. Pediatrics 1983; 71: 767–770.
Betalli P, Falchetti D, Giuliani S, Pane A, Dall’Oglio L, de Angelis GL, Caldore M, Romano C, Gamba P, Baldo V et al. Caustic ingestion in children: is endoscopy always indicated? The results of an Italian multicenter observational study. Gastrointest Endosc 2008; 68: 434–439.
Kay M, Wyllie R. Caustic ingestions in children. Curr Opin Pediatr 2009; 21: 651–654.
Poley JW, Steyerberg EW, Kuipers EJ. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc 2004; 60: 372–377.
Lee M. Caustic ingestion and upper digestive tract injury. Dig Dis Sci 2010; 55: 1547–1549.
Cakal B, Akbal E, Köklü S, Babalı A, Koçak E, Taş A. Acute therapy with intravenous omeprazole on caustic esophageal injury: a prospective case series. Dis Esophagus 2013; 26: 22–26.
Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956–2006. Clin Toxicol (Phila) 2007; 45: 402–408.
Pelclová D, Navrátil T. Do corticosteroids prevent oesophageal stricture after corrosive ingestion? Toxicol Rev 2005; 24: 125– 129.
Ozokutan BH, Ceylan H, Ertaskin I, Yapici S. Pediatric gastric outlet obstruction following corrosive ingestion. Pediatr Surg Int 2010; 26: 615–618.
Shukla RM, Mukhopadhyay M, Tripathy BB, Mandal KC, Mukhopadhyay B. Pyloric and antral strictures following corrosive acid ingestion: a report of four cases. J Indian Assoc Pediatr Surg 2010; 15: 108–109.
Lebeau R, Coulibaly A, Kountélé Gona S, Koffi Gnangoran M, Kouakou B, Yapo P, Assohoun T, Kanga Miessan JB. Isolated gastric outlet obstruction due to corrosive ingestion. J Visc Surg 2011; 148: 59–63.