Abstract

Aim: To analyse patients admitted to our unit due to caustic ingestion retrospectively and to evaluate our current approach.

Materials and Methods: Six hundred and eightyone patients admitted to our clinic due to caustic ingestion between 2000-2012, were retrospectively analysed. 413 of patients were male while 268 of them were female, and the mean age was 3,92 (±2.1). In 366 of cases the caustic was acidic and in 262 was basic. Patients were analysed in two groups according to the time of admission to our clinic. 462 patients admitted to our clinic in first 48 hours after caustic ingestion were stoped oral feeds and endoscopy was performed. Patients presenting 48 hours after caustic ingestion were managed according to their complaints.

Results: According to endoscopy findins, 187 patients were identified to have some degree of caustic esophageal burn. In 52 patients grade 1, in 123 patients grade 2 and in 12 patients grade 3 caustic esophagal burn was diagnosed. All the patients diagnosed with grade 2 or 3 caustic esophagus burn were medically treated by IV antibiotics, steroid and H2 receptor antogonist and fed through a nasogastric tube. Oral feeds were initiated after findings of recovery on control endoscopy that was performed 15 days after the first one. An esophagogram was performed in all patients after three weeks from discharge. 54 patients (% 29) were admitted for baloon dilatation programme due to stricture development. The mean dilatation number was 8.07 (±8.1). Colon interposition was performed in 12 of those patients. Gastrostomy was performed in 2 patients while gastroduodenostomy in one.

196 patient were admitted to our clinic 48 hours after caustic ingestion. In 108 of them (% 55) stricture developed in the follow up period. The mean dilatation number was 7.15 for this group. Colon interposition was performed in 12, resection and anastomosis in 2 patients. Four pyloroplasty, 5 gastroduodenostomy, and 9 gastrostomies were performed. One patient died due to severe burn after performing gastrectomy, esophagectomy and duodenostomy. Tracheostomy, gastrostomy and esophagostomy was performed in one patient due to severe esophageal and tracheal burn.

Conclusion: Caustic burn of esophagus and stomach leads to severe morbidity and mortality. It has positive effects on prognosis to stop enteral feeding early after ingestion and start appropriate medical therapy. In case of surgery patients own esophagus must be preserved.