Stent biodegradable como tratamiento de la estenosis esofágica benigna refractaria / Biodegradable stent as treatment of refractory benign esophageal stricture (RBES)

Paciente mujer de 26 años de edad, natural y procedente de La Paz-Bolivia. Acudió con un tiempo de enfermedad de 15 meses caracterizado por disfagia progresiva. Un mes antes del comienzo de la sintomatología ingirió lejía con intenciones autolíticas. En el estudio de endoscopia digestiva alta diagnóstica se evidenció a los 25 centímetros de la arcada dentaria una estenosis, de unos 3 mm de diámetro, central y con el epitelio esofágico adyacente de aspecto conservado. En la radiografía de esófago contrastada se evidenció a nivel de tercio medio de esófago una estenosis tubular corta, de bordes lisos, de aproximadamente 2 cm de longitud. Se inició tratamiento mediante dilataciones mecánicas axiales con bujías Savary Guilliard con un intervalo entre sesiones de 2 a 3 semanas y con 8 sesiones en total. En la última sesión la bujía de mayor calibre usada fue 12,8 mm. Es entonces que tomando en consideración los criterios diagnósticos de Kochman, se hizo el diagnóstico de estenosis esofágica cáustica refractaria. Durante el periodo de realización de las dilataciones con bujías la paciente quedo embarazada, lo que dificultaba la realización de los procedimientos por el rutinario uso de control fluoroscópico. Con 14 semanas de gestación se implantó un Stent esofágico biodegradable no cubierto SX-ELLA de 10 cm de longitud. Presentamos el caso por ser un manejo alternativo y novedoso para este tipo de patología.

A 26-year-old female patient, from La Paz-Bolivia. She came with a disease period of 15 months characterized by progressive dysphagia. One month before the onset of the symptomatology she ingested bleach with autolytic intentions. In the study of diagnostic upper gastrointestinal endoscopy at 25 centimeters of the dental arch was evidenced a stenosis of about 3 mm in diameter, central and with adjacent esophageal epithelium of a preserved appearance. In the x-ray of contrasted esophagus at the level of the middle third of the esophagus was evidenced a stenosis, short tubular, with a smooth border, of approximately 2 cm in length. Treatment was initiated using axial mechanical dilatations with Savary Guilliard bougies with an interval between sessions of 2 to 3 weeks and with 8 sessions in total. In the last session the largest bougie used was 12.8 mm. It is then that taking into account the diagnostic criteria of Kochman, the diagnosis of refractory caustic esophageal stenosis was made. During the period of realization of the dilations with bougies the patient became pregnant, which made difficult the accomplishment of the procedures for the routine use of fluoroscopic control. At 14 weeks of pregnancy, a SX-ELLA uncovered biodegradable esophageal stent of 10 cm length was implanted. We present the case as an alternative and novel management for this type of pathology.

Quemaduras por ácido acético: caso clínico y revisión de la literatura / Burns by Acetic Acid. Clinical case and literature review

Introducción. Las infecciones son la segunda causa de muerte materna en países de bajos ingresos. El ácido acético se conoce en la actualidad como un potente antiséptico de amplio espectro para gran positivos, gran negativos, hongos y protozoos, a través de su acción biocida y su acción biostatica, produciendo coagulación y precipitación de las proteínas, alterando las características de la permeabilidad celular y toxicidad o envenenamiento de los sistemas enzimáticos de las bacterias. Las quemaduras por ácido acético son infrecuentes y va depender para que se produzca injuria de la dilución, concentración, tiempo de exposición. Caso clínico: Se presenta el caso de una paciente de 25 años, parto por cesárea con infección y dehiscencia del sitio la herida quirúrgica tratada con antibioticos de amplio espectro, sin mejoría. Se manejó con ácido acético, provocando quemadura de segundo grado en borde de herida y pubis Discusion: El riesgo de sufrir quemaduras por ácido acético aumenta dependiendo de la tolerabilidad del paciente, el grado de concentración, dilución y el tiempo de exposición de este agente antiséptico tópico. Conclusión: Aunque las quemaduras por ácido acético son infrecuentes, siempre es necesario tener presente la dilución de la concentración adecuada y el tiempo de exposición al ácido acético, ya que dependiendo de la tolerabilidad cambia el pronóstico y tratamiento

Caustic ingestion in children in south of Iran: Retrospective study from Shiraz - Iran / Ingestión de cáusticos en niños del sur de Irán: Estudio retrospectivo de Shiraz - Irán

Caustic ingestion is a major health concern in both developed and developing countries, that may lead to serious esophageal injury. The clinical presentation of caustic ingestion in children vary from asymptomatic to serious and fatal sequelae, such as perforation and stricture formation. Objective: Due to the lack of a comprehensive study in our area, this study has evaluated clinical and endoscopic manifestations and complications of caustic ingestion in children in south of Iran. Materials and methods: In this retrospective study, we reviewed 75 children with caustic ingestion who admitted in Nemazee Hospital of Shiraz University of Medical Science during 6 years (2006-2011). Sign and symptoms were recorded for each case. Results: The most common symptoms were dysphagia, oral lesions, vomiting, and drooling. Esophageal injuries were detected in both acid and alkali ingestion, but gastric injuries was significantly more in acid ingestion. During follow up period, 20% of all cases developed esophageal stricture. Conclusion: Dysphagia, oral lesions, vomiting, and drooling were the most common findings. Esophageal stricture was found in 20% of cases during 3 months of follow up.

La ingestión de cáusticos es una gran preocupación de salud tanto en países desarrollados como en vías de desarrollo, que puede llevar a lesiones esofágicas graves. La presentación clínica de la ingestión de cáusticos en niños varía desde asintomática hasta tener secuelas fatales, como perforación y/o estenosis. Objetivo: Debido a la ausencia de estudios en nuestra área, este estudio ha evaluado las manifestaciones clínicas, endoscópicas y las complicaciones de la ingesta de cáusticos en niños en el sur de Irán. Materiales y métodos: En estudio retrospectivo, revisamos 75 niños con ingesta de cáusticos que ingresaron al Nemazee Hospital of Shiraz University of Medical Science durante 6 años (2006-2011). Los signos y síntomas fueron recolectados para cada caso. Resultados: Los síntomas más frecuentes fueron disfagia, lesiones orales, vómitos y salivación. Las lesiones esofágicas se detectaron tanto en ingestión de ácido como de álcali, pero las lesiones gástricas fueron definitivamente más frecuentes con la ingestión de ácidos. Durante el periodo de seguimiento el 20% de los casos desarrolló estrechez esofágica. Conclusión: La disfagia, lesiones orales, vómitos y salivación fueron los hallazgos más comunes. La estrechez esofágica se encontró en el 20% de los casos durante los tres meses de seguimiento de los pacientes.

Lipoenxertia subcicatricial associada à rigottomy: uma análise clínica e microestrutural / Subcicatricial fat grafting associated with rigotomy: a clinical and microstructural analysis

INTRODUÇÃO: O aumento da sobrevida na fase aguda do paciente grande queimado faz também aumentar a prevalência das sequelas cicatriciais estético-funcionais. Ao pensarmos na relevância clínica da lipoenxertia subcicatricial, necessita-se da compreensão e avaliação microscópica das reais alterações após o procedimento. MÉTODOS: Foram selecionados oito pacientes, vítimas de queimadura por álcool, com tempo médio após queimadura de 12 meses (10-14 meses), sendo submetidos à lipoenxertia subcicatricial associada à Rigottomy. Foram realizadas biópsias cutâneas no pré e pós-operatório tardio com 14 semanas. Avaliados os quesitos: 1 - Melhora estético funcional da cicatriz pela escala de Vancouver; 2 - Análise quantitativa e qualitativa do colágeno cicatricial; 3 -Análise imunohistoquímica da vascularização cicatricial com anti-fator de crescimento derivado do endotélio vascular (antiVEGE). RESULTADOS: Ao compararmos o período pré e pós-lipoenxertia, pôde-se avaliar que houve melhora estético-funcional significativa e, microscopicamente, redefinição entre os limites da derme papilar e reticular; redução quantitativa e reorganização do colágeno, além do decréscimo da vascularização tecidual pela análise imunohistoquímica. CONCLUSÃO: O princípio básico de todo processo cicatricial fisiológico é reestabelecer a homeostasia local, ou seja, as etapas exageradamente intensificadas levam a alterações clínicas catastróficas. Ao realizar a lipoenxertia subcicatricial associada à Rigotomia, foi verificada, neste estudo, a melhora qualitativa e quantitativa do tecido. Sendo assim, torna-se evidente o futuro promissor deste procedimento para a complementação terapêutica das patologias cicatriciais.

INTRODUCTION: The increase in survival of large burn patients during the acute phase has also increased the prevalence of esthetic-functional scarring sequelae. With regard to the clinical relevance of subcicatricial fat grafting, the actual changes after the procedure need to be understood and microscopically evaluated. METHODS: Eight patients with alcohol burns, with an average time after burn of 12 months (10-14 months), who underwent subcicatricial fat grafting associated with rigotomy were selected. Skin biopsies were performed in before and 14 weeks after operation. The following issues were assessed: 1) esthetic-functional improvement of the scar, by using the Vancouver scar scale; 2) quantitative and qualitative analyses of cicatricial collagen; 3) immunohistochemical analysis of scar vascularization with anti-vascular endothelial growth factor (anti-VEGF) antibody. RESULTS: When comparing the pre- and post-fat grafting period, a significant esthetic-functional improvement and, microscopically, a redefinition of the boundaries of the papillary and reticular dermis were observed, as well as quantitative reduction and reorganization of collagen, in addition to the decrease of the vascularization of the tissue through immunohistochemical analysis. CONCLUSION: The basic principle of the whole physiological healing process is to reestablish local homeostasis, that is, excessively intensified steps that lead to severe clinical changes. When subcicatricial fat grafting associated with rigotomy was performed, qualitative and quantitative improvements of the tissue were verified in this study. Thus, it becomes evident that this procedure can complement the treatment of cicatricial pathologies.

Inhalación masiva de amoniaco: reporte de dos casos / Massive ammonia inhalation: report of two cases

Ammonia (NH3) is an irritant and corrosive gas whose inhalation at high concentrations mainly occurs during agricultural and industrial activities, as occupational accidents. The extent and severity of the damage depends on the concentration and time of exposure to the toxic, which can cause skin, eye, respiratory and life-threatening injuries. We present two cases of patients acutely exposed to high concentrations of NH3. Both patients survived to the acute phase of the respiratory injury, but developed chronic lung derangements.

El amoniaco (NH3) es un gas irritante y corrosivo cuya inhalación aguda en altas concentraciones se produce principalmente durante accidentes laborales en el sector agrícola e industrial. La extensión y severidad del daño depende de la concentración y tiempo de exposición al tóxico, el cual puede causar lesiones a nivel cutáneo, ocular, respiratorio y riesgo vital. Presentamos dos casos de pacientes expuestos en forma aguda a NH3 en altas concentraciones. Ambos pacientes sobrevivieron a la fase aguda y evolucionaron con lesiones respiratorias crónicas.

The use of mitomycin C in caustic esophagitis in rats

PURPOSE: To evaluate the topical effects of mitomycin C (MMC) in rats, with or without esophageal dilation, in different moments after esophageal caustic injury with NaOH10%. METHODS: Forty eight Wistar rats were divided into six groups: "GS" infusion of 0.9% saline solution in the esophagus; "CG" infusion of 0.9% saline solution in the esophagus, with temporary ligation of the organ; "NTG" induction of a caustic lesion without treatment; "GmmcD0" MMC applied immediately after the caustic injury; "GmmcD14" MMC applied 14 days after the caustic injury; "Gdil+mmcD14" esophageal dilation and application of MMC 14 days after caustic injury. We performed contrast esophagograms of four animals from each group, seven and 21 days after the caustic injury. On day 28, all animals were sacrificed, and histopathological analyses were performed on the esophageal specimens. RESULTS: The contrast images showed total stenosis in NTG and GmmcD0, improving to partial stenosis in GmmcD0. In GmmcD14 and Gdil+mmcD14, two animals of each group improved to partial stenosis. By histopathological analysis, NTG and GmmcD14 presented intermediate damage and GmmcD0 and Gdil+mmcD14 severe damage. CONCLUSION: The use of mitomycin C had beneficial effects specially when applied immediately after the induction of esophageal lesions.

A hospital-based epidemiological study of corrosive alimentary injuries with particular reference to the Indian experience.

Corrosive alimentary tract injuries are a source of considerable morbidity all over the world. Despite this, actual data on the epidemiology of this problem are scarce mainly due to the lack of a well-established reporting system for poisoning in most countries. The burden of the disease is naturally more in countries such as India where the condition is common because of poor regulation of sale of corrosive substances. We analyse the available data on epidemiology of corrosive injuries, as well as patterns of involvement of the alimentary tract, with special reference to Indian data, and also provide an overview of the management options and long-term sequelae of this condition.

Ação do bevacizumabe subconjuntival na neovascularização e re-epitelização corneana 25 dias após queimadura química / Effect of subconjunctival bevacizumab on corneal neovascularization and reepithelization 25 days after chemical burn

OBJETIVOS: Avaliar a ação do bevacizumabe subconjuntival em modelo experimental de neovascularização em córnea de coelho. Analisar se o modelo de avaliação empregado é adequado e comparar entre os grupos a extensão dos vasos, inflamação e re-epitelização da córnea. MÉTODOS: Estudo experimental, prospectivo em 20 coelhos submetidos a trauma químico com hidróxido de sódio a 1 N divididos em dois grupos, Imediatamente após a queimadura, o grupo tratado recebeu injeção subconjuntival de 0,15 ml (3,75 mg) de bevacizumabe e o grupo controle, injeção subconjuntival de 0,15 ml de soro fisiológico a 0,9 por cento. Após 25 dias, foi realizada análise fotográfica digital para avaliar a extensão e inflamação/calibre dos vasos segundo critério pré-estabelecido e estudo histopatológico da córnea, no qual foi avaliado o estado do epitélio e o número de polimorfonucleares. RESULTADOS: A extensão dos neovasos corneanos foi menor no grupo estudo em relação ao controle (p<0,001). Não houve diferença significativa entre os grupos na inflamação/calibre dos vasos. A análise histopatológica mostrou que não ocorreu diferença entre os grupos nas variáveis estado do epitélio e número de polimorfonucleares. A análise de concordância para a variável extensão dos vasos e para a variável inflamação/calibre dos vasos teve uma estimativa do coeficiente de Kappa respectivamente de 0,705 e 0,500 indicando bom grau de concordância nas diferentes avaliações cegadas, validando o método empregado. CONCLUSÕES: O modelo de avaliação foi adequado e pode ser reproduzido para avaliar outras drogas na córnea. O bevacizumabe inibiu a neovascularização corneana, porém não foi eficaz em reduzir o processo inflamatório. A droga não atrasou a re-epitelização da córnea.

PURPOSES: To evaluate the effect of subconjunctival bevacizumab in an experimental model of neovascularization in rabbit cornea. Determine its effect on vessels extension, inflammation, epithelialization of the cornea and whether the evaluation method used is appropriate to compare neovascular models. METHODS: Experimental, prospective, randomized, blinded study in twenty rabbits subjected to chemical trauma with sodium hydroxide at 1N divided into two groups. The study group received subconjunctival injection of 0.15 ml (3.75 mg) of bevacizumab and was compared with the control group that received subconjunctival injection of 0.15 ml saline solution. After 25 days, digital photographic analysis was performed to assess the vessel's extension and inflammation/diameter according to pre-established criteria. Histopathology of the cornea, which evaluated the state of the epithelium and the number of polymorphonuclear cells was also studied. RESULTS: The length of the neovessels was greater in the control group compared to the study group (P=<0.001). There was no difference in inflammation/vessel diameter between groups. Histopathology analysis showed that there was no difference between groups for the variables state of the epithelium and number of polymorphonuclear cells. The concordance analysis for the variable extension of the vessels and the variable inflammation/vessel diameter was estimated with Kappa coefficients of 0.705 and 0.500 respectively, indicating a good level of agreement in different evaluations and validating the method. CONCLUSIONS: The experimental model is adequate and can be reproduced to evaluate other drugs in the cornea. Bevacizumab inhibit the neovessels' growth but was not effective in preventing the inflammatory response. The drug did not delay the reepithelialization of the cornea.

The effect of subconjunctival bevacizumab on corneal neovascularization, inflammation and re-epithelization in a rabbit model

PURPOSE: To evaluate the use of subconjunctival bevacizumab on corneal neovascularization in an experimental rabbit model for its effect on vessel extension, inflammation, and corneal epithelialization. METHODS: In this prospective, randomized, blinded, experimental study, 20 rabbits were submitted to a chemical trauma with sodium hydroxide and subsequently divided into two groups. The experimental group received a subconjunctival injection of bevacizumab (0.15 m; 3.75 mg), and the control group received an injection of 0.15 ml saline solution. After 14 days, two blinded digital photograph analyses were conducted to evaluate the inflammation/diameter of the vessels according to pre-established criteria. A histopathological analysis of the cornea evaluated the state of the epithelium and the number of polymorphonuclear cells. RESULTS: A concordance analysis using Kappa's statistic showed a satisfactory level of agreement between the two blinded digital photography analyses. The neovascular vessel length was greater in the control group (p<0.01) than in the study group. However, the histopathological examination revealed no statistically significant differences between the groups in terms of the state of the epithelium and the number of polymorphonuclear cells. CONCLUSIONS: Subconjunctival bevacizumab inhibited neovascularization in the rabbit cornea. However, this drug was not effective at reducing inflammation. The drug did not induce persistent corneal epithelial defects.

Estenoses benignas de esôfago: abordagem endoscópica com velas de Savary-Gilliard / Benign strictures of the esophagus: endoscopic approach with Savary-Gilliard bougies

RACIONAL: As estenoses benignas de esôfago são complicações decorrentes de diversas causas. Possuem tratamentos similares, na maioria dos casos necessitando de dilatação endoscópica, no entanto a resposta terapêutica, tempo ideal de tratamento, assim como intervalo entre as sessões podem ser variáveis. OBJETIVO: Analisar, do ponto de vista endoscópico, as estenoses benignas de esôfago em 14 anos de experiência no Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, RJ, avaliando etiologia, a extensão da estenose, o número de dilatações necessário para atingir resposta terapêutica satisfatória, assim como a relação entre a extensão da estenose e a resposta terapêutica. MÉTODO: Foram analisadas 2.568 dilatações endoscópicas com uso de velas de Savary-Gilliard em 236 pacientes, durante um período de 14 anos e 10 meses, até junho de 2007. RESULTADOS: A estenose péptica foi a causa mais freqüentemente encontrada, seguida pela estenose cáustica. As estenoses longas e cáusticas necessitaram de maior número de sessões para ausência de disfagia. Estenoses pépticas e curtas responderam melhor a número menor de sessões de dilatação. CONCLUSÃO: A estenose péptica foi a causa mais comum e respondeu bem à terapia endoscópica, em concordância com a literatura. As estenoses cáusticas foram as mais refratárias, principalmente as longas. Quanto maior foi a extensão da estenose, também maior foi o número de sessões necessárias. Estenoses curtas apresentaram boa evolução na maioria dos casos. O número de dilatações necessárias dependeu diretamente da causa e da extensão da estenose.

BACKGROUND: Benign esophageal strictures are complications that result from different causes. They are usually similarly approached, most of the cases needing endoscopic dilation. However the response to therapy, optimal timing for treatment and interval between sessions can vary. AIM: The authors evaluate 14 years of experience with benign stricture of the esophagus from the endoscopic point of view in the "Clementino Fraga Filho" University Hospital, Federal University of Rio de Janeiro, RJ, Brazil. They evaluated etiology, length of stricture, number of dilations needed to reach satisfactory therapeutic response, and the relation between length of stricture and therapeutic response. METHODS: We analyzed 2,568 endoscopic dilations using Savary-Gilliard dilators in 236 patients. The follow up period was 14 years and 10 months, until June of 2007. RESULTS: Peptic strictures were the more frequent, followed by caustic strictures. Long strictures and caustic strictures needed more sessions to abolish dysphagia. Peptic strictures and short ones had better response to a smaller number of sessions. CONCLUSION: In this study, peptic strictures were the commonest etiology and responded best to endoscopic therapy, in accordance with published literature. Caustic strictures were the most refractory, mainly the long segments. The longer the extension of stenosis, the greater was the number dilation sessions needed for relief. Short strictures had a good prognosis in the great majority of cases. The number of dilations depended directly on the etiology and the extension of the stricture.

Lesões esofagianas causadas por ingestão de substâncias cáusticas ou corrosivas / Esophageal lesions caused by ingestion of caustic or corrosive agents

A ingestão de cáusticos ou corrosivos constitui importante situação de emergência. Objetivo - analisar os aspectos clínicos de indivíduos que referiam tentativa de suicídio, utilizando para tal a ingestão de cáusticos ou corrosivos. Pacientes e métodos - estudou-se 34 pacientes. A substância ingerida pela maioria (32) foi soda cáustica (NaOH) e os demais referiram ácido clorídrico (HCI). Apenas três pacientes foram encaminhados na fase aguda do acidente, os demais já apresentavam as sequelas, comprovadas por endoscopia, a qual revelou estenose esofágica em 30 / The ingestion of caustic or corrosive agents is an important emergency situation. Aim - To analyze the clinical aspects of patients who attempted suicide by ingesting caustic or corrosive substances. Patients and method - this study included 34 patients. Most of them (32) ingested caustic soda (NaOH) and the others hydrochloric acid (HCI). Only three patients were referred during the acute phase of the accident; the others already presented sequelae, corroborated by endoscopic studies, revealing that 30 of them had esophagic stenosis...

Self-bougienage: long-term relief of corrosive esophageal strictures.

BACKGROUND: Corrosive esophageal strictures require dilatation at frequent intervals. OBJECTIVE: To determine the efficacy of self-dilatation in treatment of corrosive esophageal strictures. METHODS: Retrospective analysis of data from 51 patients with corrosive esophageal strictures seen in a surgical unit. Eighteen patients underwent per-oral antegrade dilatation of stricture using gum elastic bougies (Group I); 15 patients underwent retrograde dilatation with endless string using an India rubber dilator devised at the authors' institution, followed by per-oral antegrade dilatation (Group II); 15 patients underwent retrograde dilatation followed by antegrade dilatation with endless string through esophagostomy (Group III). In three patients with stricture of the entire esophagus, endless string could not be passed; they were subjected to esophagocoloplasty. All patients were taught self-dilatation with gum elastic bougies as the final step, and were put on a progressive, domiciliary, self-dilatation program. Quarterly follow up was done for one year, to ascertain whether self-bougienage was being performed properly. RESULTS: All patients responded well to treatment, with significant relief of dysphagia and improvement in health and barium study findings. Six patients developed mediastinitis (3, 2 and 1 in Groups I, II and III, respectively) during initial dilatation; all improved with conservative management. Only one patient who failed to carry out self-bougienage had to be readmitted and retrained in the procedure, after which he remained asymptomatic. CONCLUSIONS: Patients with corrosive esophageal strictures can be treated with a long-term self-bougienage program, which avoids the need for frequent hospital admissions for esophageal dilatation.

Ingestion of caustic substances and its complications

CONTEXT: Caustic substances cause tissue destruction through liquefaction or coagulation reactions and the intensity of destruction depends on the type, concentration, time of contact and amount of the substance ingested. OBJECTIVES: To analyze the complications in patients who ingested caustic substances and correlate them with the amount of caustic soda ingested. DESIGN: Retrospective study. SETTING: University hospital, a referral center. PARTICIPANTS: A total of 239 patients who ingested caustic soda. MAIN MEASUREMENTS: The amount of granulated caustic substance ingested was measured as tablespoonfuls and the following complications were analyzed: esophagitis, esophageal stenosis and progression to cancer, fistulas, perforations, stomach lesions, brain abscesses, and death. Stenosis was classified as mild, moderate or severe according to the radiological findings. RESULTS: We observed an 89.3 percent incidence of esophagitis; 72.6 percent of the cases involved progression to stenosis and 1 percent died during the acute phase. Stenosis was mild in 17.6 percent of cases, moderate in 59.3 percent and severe in 23 percent. The incidence of stenosis was 80.8 percent in women and 62.5 percent in men. The incidence of stenosis was 46.9 percent in the group that ingested

Fístula tráqueo-esofágica posterior a ingesta de cáusticos y su manejo quirúrgico / Surgical management of tracheoesophageal fistula after caustic ingestion

Introducción. La ingesta de cáusticos provoca lesión por inflamación y necrosis del esófago y tejidos adyacentes como es la vía respiratoria. La fístula tráqueo-esofágica por ingesta de cáusticos es una complicación grave. Caso clínico. Masculino de 4 años de edad quien ingiere cáustico líquido. La panendoscopia demostró quemaduras en orofaringe y totalidad del esófago grado II-III profundas; estómago con lesiones severas, úlcera extensa en antro y píloro. A los 20 días se realizó gastrostomía y anastomosis gastro-duodenal por estenosis total del píloro. Dos meses después presentó tos, sialorrea y pérdida de peso. Se le realizó broncoscopia encontrando fístula tráqueo-esofágica y estenosis total del esófago por lo que fue sometido a aislamiento esofágico mediante esofagostomía cervical, sección y sutura esofágica distal, además de paso de sonda de yeyunostomía. Ocho meses después se realizó transposición de colon. Conclusiones. El manejo de la fístula tráqueo-esofágica secundaria a ingestión de cáusticos es difícil. Diagnosticada la fístula, el aislamiento esofágico total evita la contaminación por saliva o jugos gástricos, protegiendo así los pulmones de lesión recurrente.