Diagnostics and Therapy of Esophagus Etching at the Child Age
Janoušek P., Kabelka Z., Fajstavr J., Lesný P., Jurovčík M., Šnajdauf J.2, Soukup J.1, Rygl M.2
Klinika ušní, nosní a krční 2. LF UK, FN Motol, Subkatedra dětské otorinolaryngologie IPVZ, Praha přednosta doc. MUDr. Z. Kabelka Ústav patologie a molekulární medicíny 2. LF UK, FN Motol, Praha1 přednosta prof. MUDr. R. Kodet, DrSc. Klinika dětské chirurgie 2. LF UK, FN Motol, Praha, Subkatedra dětské chirurgie IPVZ, Praha2 přednosta prof. MUDr. J. Šnajdauf, DrSc. |
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Summary:
Patients with the diagnosis of suspect etching esophagus form 15% of all acute admission to the hospital of
patients at our clinic. In view of severity of the affection, possible consequences and complications the authors
consider early diagnostic and therapeutic measures of primary importance in all cases of suspected intake
(swallowing) of corrosive compounds to be performed at a specialized ORL workplace. Such ward should dispose
with an emergency workplace experienced with poisonings and a surgical workplace where operations on the
thoracic part of esophagus have been made. Basic procedures include especially an early rigid esophagoscopy for
the determination of the degree of etching; flexible esophagoscopy is considered risky. The esophagoscopic findings
make it possible to classify etching into for degrees: patients with etching of the first degree are only under
observation, while the findings of 2nd and 3rd degree are indicated for introduction of nasogastric probe for the
period of six weeks, two-stage corticoid therapy and administration of intravenous antibiotics in the first week
after injury. In cases of 4th degree etching the probe is left for a longer period of time, the esophagus lumen is
maintained as wide as possible and collaboration with the surgeon is taken into account as well as most suitable
time for esophagus replacement.
Edema of the larynx entrance is the most frequent acute complication of esophagus etching,whichmust be treated,
in cases of insufficient pharmacological intervention, with intubation, while free access into respiratory pathways
should be secured by tracheotomy exceptionally. Post/corrosive stricture is themost frequent late complication, but it
mostly reacts well to balloon dilatation. Extensive stricture limiting the esophagus lumen and thereby worsening food
intake, which cannot be successfully treated with balloon dilatation, are indicated for esophagus replacement.
Mediastinitis and aortal-esophagus fistula is the most severe complication in the region of thorax.
The prognosis of patients with esophagus etching of 1st to 3rd degree is generally favorable. The etching of IVth
degree is a serious life-threatening condition. The present diagnostic-therapeutic procedures ensue from published
results of research.
Key words:
etching, children, rigid esophagoscopy
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