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How commonly used items at home, when ingested can cause utterly horrific internal burns

How commonly used items at home, when ingested can cause utterly horrific internal burns

  • June-23-2017

Corrosive Injuries of Esophagus

An 18 year old Iraqi girl, Sabina (name changed) who had accidently ingested acid one and half years back, could not eat anything by mouth except small amounts of liquids. The Gastroenterology team at Sarvodaya did a pre op assessment by GI endoscopy and revealed a diffusely stenosed esophagus with inability to pass the scope beyond the narrowing. Doctors at Centre for General & Gastrointestinal Surgery, after discussion with patient, opted Esophageal replacement for her. Intra-operatively it was found that her stomach was too small so a colonic transposition was done, wherein, her right colon was mobilized and a new conduit was fashioned and attached proximally to the cervical esophagus and distally to stomach to create a new food pipe. Two weeks post-surgery, Sabina was taking a normal diet by mouth and was happy to go home.

The use of toilet cleaners, bleeches and detergents is common at home, but when ingested they can prompt a potentially lethal chemical reaction.

Corrosive ingestion typically represents the ingestion of strongly alkaline or acidic household or industrial products. At home Alkalis are normally found in drain openers, toilet cleaners, bleeches and detergents. And Acids are present in toilet bowel cleaners, anti-rust compounds and battery fluids.

Accidental corrosive injuries are usually found among children; intensity is low because of small volume of substance ingested. In adults and teens the ingestion is usually deliberate and suicidal and the injuries are accordingly more severe.

The severity of acute injury depends upon:

  • Type of substance ingested- acid vs alkali: acids cause coagulative necrosis which leads to eschar formation which limits its penetration. Alkalis cause liquefactive necrosis and, therefore, penetrate more deeply……...Acids lick the esophagus and bite the pylorus.

  • The form of substance- solid or liquid: liquid trickles down and involves a larger area whereas solids remain in contact with a particular area for long and cause much serious damage.

  • The quantity of substance ingested.

  • The amount of residual food in the stomach.

The ingestion of corrosives can result in superficial, partial thickness or full thickness injury with perforation of food pipe (esophagus) and/or stomach.

Initial management

If a person has ingested alkali, it can be neutralized by vinegar, lime juice or orange juice. Acids can be neutralized with milk, egg white or antacids but is most effective if done within the first hour of ingestion.

  • Ensure proper breathing of the patient by securing the airway. This may entail doing a tracheostomy in severe cases.

  • Hospitalization is required for observation to evaluate the severity of injury.

  • Esophageal and/or stomach perforation needs immediate surgery.

  • Upper GI endoscopy can be done within 24 hours but not beyond that as risk of perforation is higher.

  • Nothing by mouth, Pain management, Hydration and prevention of infection remain the corner stones of initial management.

  • Nutritional support in the initial days can be via parenteral route and beyond a week a feeding jejunostomy is done if feeding by mouth remains an issue.

There can be long term complications of corrosive ingestion like formation of esophageal and/or stomach strictures.

Management of Esophageal Strictures

Many patients require frequent dilatations via endoscopy to enable oral feeding which severely affects their quality of life. Patients with more severe strictures need prolonged feeding jejunostomy. Definitive treatment includes esophageal replacement or bypass surgery using either stomach (if it itself is not involved in the disease process) or colon for esophageal replacement or bypass. In such surgeries a conduit made of either stomach or colon (usually left colon) is fashioned and attached proximally to cervical esophagus and distally to stomach or jejunum (if stomach too is involved and scarred) with or without removal of affected esophagus for allowing oral feeding.

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