Corrosion
of Esophagus in Children
Janoušek P., Kabelka Z., Fajstavr J., Lesný P., Jurovčík M., Šnajdauf J.**, Soukup J.*, Rygl M.**
Klinika ušní, nosní a krční 2. LF UK a FNM, Praha, Subkatedra dětské otorinolaryngologie IPVZ, Praha, přednosta doc. MUDr. Z. Kabelka Ústav patologie a molekulární medicíny 2. LF UK a FNM, Praha,přednosta prof. MUDr. R. Kodet, DrSc.*Klinika dětské chirurgie 2. LF UK a FNM, Praha,Subkatedra dětské chirurgie IPVZ, Praha,přednosta prof. MUDr. J. Šnajdauf, DrSc.** |
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Summary:
Patients with the diagnosis of suspect corrosion of esophagus form 15% of all
emergency hospitalization patients at our clinic. In view of the severity of the disease, its possible
consequences and complications, all cases of suspected swallowing of caustic compounds are given
priority for early diagnostic-therapeutic measures at specialized otolaryngology ward, which
disposes of the emergency unit experienced in poisoning, and a surgery ward capable of operation
on the thoracic part of esophagus. The basic procedures include particularly the timely rigid
esophagoscopy for estimating the degree of corrosion; flexible esophagoscopy is considered of
posing a risk. The esophagoscopy finding enables to classify the corrosion into four degrees
according to our working classification. The patients affected by corrosion of the Ist degree are only
subject to observation, whereas the finding of corrosion of the IInd or IIIrd degree indicates that
the nasal-gastric probe is to be introduced for the period of six weeks and the therapywith two-stage
corticoid treatment and intravenous administration of antibiotics during the first week after the
injury. In cases of corrosion of the IVth degree the probe is applied for a longer period of time
together with an effort to maintain esophagus as wide as possible and the replacement of esophagus
is considered in collaboration withsurgeons at the most suitable period of time.
Edema of the entry into larynx is the most frequent acute complication of corrosion of swallowing
passages; it is treated by a pharmacological intervention and, whenever insufficient, intubation or,
exceptionally, tracheotomy must be made to secure respiratory pathways free. A post-corrosion
stricture, which mostly responds to a balloon dilatation favorably, is the most frequent late complication.
Extensive strictures limiting the esophagus lumen, which deteriorate the possibility for
intake of food and do not respond to balloon dilatation favorably, represent indication for esophagus
replacement. Mediastinitis and aorta-esophagus fistula represent the most serious complications.
The authors then analyze a cohort of children patients treated for suspect corrosion of esophagus
treated at the Otolaryngology Clinic, 2nd Medical Faculty, Charles University, in the years 1991 to
2001. All the patients were treated according to a uniform diagnostic-therapeutic protocol.
In the period of observation, 275 patients were examined. When the early rigid esophagoscopy was
applied, negative findings were observed in 156 (56.7%) patients, corrosion of the Ist degree in 47
(17.1%) patients, corrosion of the IInd or IIIrd degree in 62 (22.5%) patients and the IVth degree in
10 (3.6%) patients. Two patients with corrosion of the IVth degree died. The death was caused by
untreatable mediastinitis withde veloping multiorgan failure. One female patient, who suffered
from corrosion of the IVth degree is still affected by a severe post-corrosion stricture which may
can not be influenced by the balloon dilatation. All the other patients are completely without any
complaints.
Key words:
corrosion of esophagus, children, nasal-gastric probe, rigid esophagoscopy.
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