Sociodemographic and clinical profile of patients with occupational contact dermatitis seen at a work-related dermatology service, 2000 - 2014

Abstract: BACKGROUND: Occupational dermatoses are common, especially contact dermatitis. Epidemiological studies on these dermatoses are scarce in Brazil and they are necessary as part of the public policy to protect workers' health. OBJECTIVES: To identify sociodemographic and clinical profile of patients with occupational contact dermatitis seen between 2000 and 2014 at an occupational dermatology service. METHODS: It is a cross-sectional and retrospective study, based on information obtained from the service's database. RESULTS: Of 560 patients with conclusive patch test, 289 (46.9%) presented occupational dermatoses and 213 occupational contact dermatitis with predominance of the allergic type in relation to the irritative type (149:64 respectively). The odds of occupational dermatoses were higher among men and lower among patients aged 50 years or older and with higher level of education. Regarding the possibility of presenting occupational allergic contact dermatitis, only the gender variable was statistically significant. The professions most seen were cleaners, construction workers, painters, mechanics/metallurgists and cooks. The commonest allergens were nickel sulfate, potassium dichromate, cobalt chloride, carba-mix and formaldehyde. STUDY LIMITATIONS: The main limitations of this study are the fact that it was carried out in a tertiary service of occupational dermatoses and the lack of access to some allergens outside the patch test baseline series. CONCLUSIONS: It was possible to identify the sociodemographic and clinical profile of patients with suspected occupational contact dermatitis seen at the Service, beyond the professional groups and allergens related to a high risk of occupational contact dermatitis in this population.

Cromoscopia vital com Lugol versus cromoscopia óptica na detecção de câncer de esôfago em pacientes com estenoses cáusticas esofagianas / Lugol's iodine chromoendoscopy versus narrow band image enhanced endoscopy for the detection of esophageal cancer in patients with stenosis secondary to caustic/corrosive agent ingestion

ABSTRACT BACKGROUND The diagnosis of corrosion cancer should be suspected in patients with corrosive ingestion if after a latent period of negligible symptoms there is development of dysphagia, or poor response to dilatation, or if respiratory symptoms develop in an otherwise stable patient of esophageal stenosis. Narrow Band Imaging detects superficial squamous cell carcinoma more frequently than white-light imaging, and has significantly higher sensitivity and accuracy compared with white-light. OBJECTIVE To determinate the clinical applicability of Narrow Band Imaging versus Lugol´s solution chromendoscopy for detection of early esophageal cancer in patients with caustic/corrosive agent stenosis. METHODS Thirty-eight patients, aged between 28-84 were enrolled and examined by both Narrow Band Imaging and Lugol´s solution chromendoscopy. A 4.9mm diameter endoscope was used facilitating examination of a stenotic area without dilation. Narrow Band Imaging was performed and any lesion detected was marked for later biopsy. Then, Lugol´s solution chromoendoscopy was performed and biopsies were taken at suspicious areas. Patients who had abnormal findings at the routine, Narrow Band Imaging or Lugol´s solution chromoscopy exam had their stenotic ring biopsied. RESULTS We detected nine suspicious lesions with Narrow Band Imaging and 14 with Lugol´s solution chromendoscopy. The sensitivity and specificity of the Narrow Band Imaging was 100% and 80.6%, and with Lugol´s chromoscopy 100% and 66.67%, respectively. Five (13%) suspicious lesions were detected both with Narrow Band Imaging and Lugol's chromoscopy, two (40%) of these lesions were confirmed carcinoma on histopathological examination. CONCLUSION Narrow Band Imaging is an applicable option to detect and evaluate cancer in patients with caustic /corrosive stenosis compared to the Lugol´s solution chromoscopy.

RESUMO CONTEXTO A suspeita do câncer de esôfago na lesão cáustica ocorre quando os pacientes com estenoses previamente estáveis, após um período latente sem sintomas, apresentam disfagia, baixa resposta as dilatações ou sintomas respiratórios. A cromoscopia com luz de banda estreita detecta o câncer superficial de esôfago mais frequentemente que a luz branca, com alta sensibilidade e acurácia. OBJETIVO Determinar a aplicabilidade clínica da luz de banda estreita versus a cromoscopia vital com Lugol na detecção do câncer precoce de esôfago em pacientes com lesões cáusticas. MÉTODOS Um total de 38 pacientes, entre 28 e 84 anos, foram alocados seguidamente e submetidos à cromoscopia com luz de banda estreita e com Lugol. Um gastroscópio de 4,9 mm de diâmetro foi usado para facilitar o exame da área estenosada, sem necessidade de dilatação. A cromoscopia com luz de banda estreita era realizada primeiro e as áreas suspeitas anotadas. Depois, a cromoscopia com Lugol era realizada e as áreas suspeitas biopsiadas. RESULTADOS Detectamos nove lesões suspeitas com a luz de banda estreita e 14 com o Lugol. A sensibilidade e especificidade da cromoscopia com luz de banda estreita foi de 100% e 80,6%, e a do Lugol foi de 100% e 66,67% respectivamente. Cinco (13%) lesões suspeitas foram detectadas coincidentemente pelos dois métodos, sendo duas (40%) com diagnóstico anatomopatológico de câncer de esôfago. CONCLUSÃO A cromoscopia com luz de banda estreita é opção concreta para o diagnóstico de câncer em pacientes com estenoses esofágicas por corrosões cáusticas, comparado a cromoscopia com Lugol.

Lesiones por cáusticos del tracto digestivo superior: características clínicas y endoscópicas en el Hospital Nacional Daniel Alcides Carrión / Injuries by caustic of upper digestive tract: clinical and endoscopic features at the National Hospital Daniel Alcides Carrion

OBJETIVO: Describir las características clínicas y endoscópicas de las lesiones producidas por cáusticos en el tracto digestivo superior en pacientes del Hospital Nacional Daniel Alcides Carrión. MATERIALES Y METODOS: se realizó un estudio descriptivo, la población estudiada fue pacientes con diagnóstico de ingesta de cáusticos los cuales fueron admitidos en el servicio de Gastroenterología del HNDAC para la realización de una endoscopia digestiva alta durante el periodo de enero del 2009 a diciembre del 2012. Se documentó el tipo de sustancia caústica ingerida, causa de ingesta, cantidad ingerida, modo de ingesta, síntomas o signos presentes, hallazgos endoscópicos según la clasificación de Zargar, presencia de complicaciones y tratamiento realizado. Se realizó el análisis comparándolos según a la edad como pediátrica y adulta; y a la sustancia caústica ingerida: ácido o álcali. RESULTADOS: Se obtuvieron 98 pacientes, 91 adultos y 7 pediátricos, la edad promedio en adultos fue de 30.6±16.3 años y en pediátricos 8.7±5.3 años. Las sustancias caústicas ingeridas fueron: lejía (hipoclorito de sodio) en 75 (76 por ciento) pacientes, ácido muriático (ácido clorhídrico) en 19 (20 por ciento) pacientes, soda caústica en 3 (3 por ciento) pacientes y batería de celular (iones de litio) en 1 (1 por ciento) paciente. La cantidad promedio ingerida en adultos fue de 136ml (entre 30-500ml) y 47ml (entre 20-150ml) en pediátricos. Los síntomas y signos más frecuentes fueron: vómitos, dolor abdominal, náuseas y odinofagia. El 46 por ciento de los adultos y el 57 por ciento de los niños presentaron lesiones. El 100 por ciento de los pacientes que ingirieron ácido y el 34 por ciento de los que ingirieron álcali presentaron lesiones. Ocho (8 por ciento) pacientes presentaron lesiones orofaríngeas, 26 (27 por ciento) en esófago, 36 (37 por ciento) en estómago y 12 (12 por ciento) en duodeno. Se encontró 12 (12 por ciento) pacientes con lesiones de grado I, 16 (16 por ciento)...

OBJECTIVE: To describe the clinical and endoscopic features of caustics injuries in the upper gastrointestinal tract in patients of the National Hospital Daniel Alcides Carrión. MATERIALS AND METHODS: A descriptive study was conducted; the study population was patients diagnosed with caustic ingestion who were admitted into the Gastroenterology service of the HNDAC to perform an upper endoscopy during the period of January 2009 to December 2012. We documented the type of caustic substance ingested, cause of intake, amount ingested, intake mode, signs or symptoms present, endoscopic findings as classified by Zargar, presence of complications and treatment performed. Analysis was performed comparing them based on adult and pediatric age, and ingested caustic type: acid or alkali. RESULTS: were obtained 98 patients, 91 adults and 7 pediatrics; adults average age was 30.6±16.3 years and 8.7±5.3 years in pediatrics. Caustic substances ingested were: bleach (sodium hypochlorite) in 75 (76 per cent) patients, muriatic acid (hydrochloric acid) in 19 (20 per cent) patients, caustic soda in 3 (3 per cent) patients and cell battery (lithium-lithium) in 1 (1 per cent) patient. The average adult intake was 136ml (30-500ml) and 47ml (20-150ml) in pediatric patients. The most frequent signs and symptoms were vomiting, abdominal pain, nausea and sore throat. The 46 per cent of adults and 57 per cent of children had caustic injuries. 100 per cent of patients who ingested acid and 34 per cent who ingested alkali had lesions. Eight (8 per cent) patients had oropharyngeal lesions, 26 (27 per cent) in the esophagus, 36 (37 per cent) in the stomach and 12 (12 per cent) in the duodenum. Grade I lesions were found in 12 (12 per cent) patients, 16 (16 per cent) patients with grade II lesions and 15 (15 per cent) of patients with grade III, 12 patients who toke acid had lesions of grade III. Esophageal stricture was found in 2 patients, gastric stenosis in 7 (8 per cent) patients and...

Ingestión de sustancias Cáusticas: reporte de un caso y revisión de la literatura / Ingestion of caustic substances: a case report and literature review

Introducción: La ingestión de sustancias cáusticas (IC) en niños, continúa siendo un campo difícil, debido a la poca clara relación entre los signos y síntomas y la extensión del daño del esófago.Objetivo: Describir el caso de un niño con IC y revisar la literatura del tema. Reporte del caso: Se trata de un masculino de 1 año 8 meses de edad, sin antecedentes de importancia, quien luego de ingesta accidental de líquido de radiador contenido en un frasco de yogurt, presenta vómito en 15 oportunidades. En Centro de Salud luego de la colocación de sonda nasogástrica para lavado gástrico es remitido a un Tercer Nivel de Atención, donde se le realiza una endoscopia digestiva alta (EVDA) luego de 28 horas de la IC. El reporte de la EVDA, indicó esofagitis caústica grado IIc, gastropatía severa, y píloro no franqueable con lesiones concéntricas. El manejo incluyó ayuno, líquidos endovenosos, corticoides, penicilina, y ranitidina Discusión: La EVDA, es el método más eficiente para evaluar la mucosa del tubo digestivo superior luego de la IC, que puede tener efectos catastróficos o puede resultar inofensiva. Se ha intentado correlacionar los signos y síntomas iniciales con la gravedad de las lesiones para evitar la realización de una EVDA innecesaria, sin embargo, sigue siendo controversial este tema. El manejo médico de la IC incluye antibióticos, esteroides y bloqueadores H2. Entre las complicaciones de la IC se encuentran la perforación, la mediastinitis, las fístulas a grandes vasos, la penetración al estómago y las estenosis.

Introduction: The ingestion of caustic substances (CI) in children, remains a difficult, due to lack clear relationship between the signs and symptoms and the extent of damage of the esophagusObjective: To describe the case of a child with CI and review the literature on the subject. Case report: This is a male 1 year 8 months old, with no previous medical history, who after accidental ingestion of radiator fluid contained in a jar of yogurt, vomiting occurs in 15 opportunities. Health Center after placement of a nasogastric tube for gastric lavage is referred to a tertiary care, where she underwent an upper endoscopy (UE) after 28 hours of the CI. The report of the UE, said caustic esophagitis grade IIc, severe gastropathy, and pylorus not passable with concentric lesions. The managemen included fasting, intravenous fluids, steroids, penicillin, and ranitidine Discussion: . The UE, is the most efficient method to evaluate the upper gastrointestinal mucosa after the IC, which can have catastrophic effects and can be harmless. It has tried to correlate the signs and symptoms with the severity of injuries to avoid making an unnecessary UE, however, this issue remains controversial. The medical management of IC including antibiotics, steroids and H2 blockers. Complications of the IC are perforation, mediastinitis, fistulas to large vessels, penetrationto the stomach and stenosis.

La ingestión de cáusticos en el niño: un problema de salud pública / The caustic ingestion in children: a public health problem

La ingestión de cáusticos en la edad pediátrica es un problema grave al producir una lesión progresiva y devastadora en el esófago y el estómago. Estudio retrospectivo y descriptivo de 421 pacientes en edades comprendidas de 2 meses a 14 años quienes ingirieron cáusticos entre 1.992 y 2.008, evaluados en el Hospital Universitario de Maracaibo. El 60,09% eran pre-escolares y el 62,23% eran del sexo masculino. La sustancia tipo álcali fue ingerida en el 90,73% de los casos y los cáusticos se encontraban almacenados en su envase original en 3,8% y trasegados en el 96,2% de los casos. La ingestión fue de origen accidental en el 99,53%. Todos los pacientes manifestaron alguna sintomatología como lesiones orofaríngeas, vómitos y sialorrea. La evaluación endoscópica se realizó en el 89,31% de los casos y se evidenció lesiones en el tracto gastrointestinal en 60,63%. Los pacientes con Esofagitis Grado III y estenosis esofágica fueron incluidos en el programa de dilatación, con una buena evolución en el 35,91% de ellos. La ingestión de cáusticos constituye un problema frecuente y serio, en su mayoría de origen accidental, afecta principalmente a menores de 6 años y el álcali es el principal agente involucrado. La Endoscopia Digestiva es el estudio por excelencia para evaluar estos pacientes. Las dilataciones esofágicas son moderadamente exitosas. El mejor tratamiento es la prevención.

The caustic ingestion in the pediatric population is a serious problem because produce a progressive and devastating injury to the esophagus and stomach. Retrospective and descriptive study of 421 patients with age from 2 months to 14 years who ingested caustic between 1.992 to 2.008 evaluated at the Hospital Universitario de Maracaibo. The 60.09% were pre-school and 62.23% were male. The substance type alkali was swallowed by 90.73% of cases and the caustics were stored in its original packaging by 3.8% and decanted in 96.2% of cases. Intake was accidental source in 99.53%. All patients showed some symptoms as oropharyngeal lesions, vomiting and drooling. Endoscopy evaluation was performed by 89.31% of cases and revealed gastrointestinal tract injuries in 60.63%. Patients with grade 3 Esophagitis and esophageal stricture were admitted in the dilatation program with a good success in 35.91% of them. The caustic ingestion is a common and serious problem, mostly from accidental origin, mainly affects children under 6 years and the alkali is the principal agent involved. The Esophagoscopy is the ideal mean for evaluate these patients. The esophageal dilatations are moderately successful. The best treatment is the prevention.

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.

Tratamiento quirúrgico de las estenosis esofágicas por cáusticos: experiencia en el Hospital Universitario de Maracaibo / Surgical treatment of the caustic esophageal stenosis: experience in Hospital Universitario of Maracaibo

Evaluar los procedimientos diagnósticos y el tratamiento quirúrgico en pacientes con estenosis esofágica en el Hospital Universitario de Maracaibo. Se evaluaron en 22 pacientes con estenosis cáustica, el agente etiológico, signos y síntomas presentes, procedimientos diagnósticos, tratamiento quirúrgico, complicaciones quirúrgicas y evolución postoperatoria. Las manifestaciones clínicas más frecuentes fueron disfagia (95.45 por ciento), pérdida de peso (18.18 por ciento), odinofagia (18.18 por ciento) y dolor torácico (4.54 por ciento). La endoscopia reportó estenosis esofágica en todo el trayecto en seis pacientes (27.27 por ciento) y congestión y ulceración esofágica en seis pacientes (27.27 por ciento). Las intervenciones quirúrgicas más frecuentemente realizadas fueron: esofagectomía transhiatal + ascenso gástrico en ocho pacientes (36.36 por ciento) y ascenso colónico izquierdo en siete pacientes (31.81 por ciento). Las complicaciones postoperatorias más frecuentes fueron las relacionadas con las anastomosis tales como las fístulas cervicales y las estenosis de la anastomosis. La estenosis esofágica por cáustico es una patología esofágica de difícil tratamiento debido a la morbilidad y mortalidad relacionada con los procedimientos quirúrgicos utilizados.

Lesión digestiva alta grave por ingestión de ácido muriático (ácido clorhídrico) / Gastrointestinal injury by hydrochloric acid

La lesión digestiva aguda por caústicos es una patología que con cierta frecuencia se observa como motivo de consulta a los servicios de urgencias. Tiene un pronóstico reservado dada la cantidad de complicaciones quirúrgicas, médicas e infecciosas a las que están expuestos estos pacientes. Las secuelas que el paciente debe enfrentar en diferentes etapas de su evolución requieren de cuidados intensivos durante un tiempo prolongado además de muchos controles posteriores al alta para evaluar y tratar proiblemas de consideración, estenosis y otras lesiones faringo-esofágicas. Presentamos el caso de un adulto masculino que debido a un síndrome depresivo mayor cursa un intento suicida ingiriendo ácido muriático por boca con severa lesiones digestivas muy poco sintomáticas durante su evolución precoz, pero con un resultado fatal debido a sangrado digestivo agudo masivo.

The acute gastrointestinal injury by caustics is a condition that frequently is observed as a cause of consultations to emergency department. These patients have reserved prognosis given the number of surgical complications, medical and infections. The aftermath that the patient must face at different stages of their development require intensive care for a long time and post-discharge many patients required assess and treat problems, primarily stenosis and other injuries pharynx-esophageal. We report the case of an adult male with depressive syndrome and by suicide attempt with ingesting muriatic acid by mouth, he developed very little injuries digestive during his early trends, but with a fatal outcome due to acute massive gastrointestinal bleeding.

Características clínicas, epidemiológicas y terapéuticas de la ingestión de cáusticos: estudio de 40 casos / Clinical, epidemic and therapeutic characteristics of the ingestion of caustic: I study of 40 cases

Se realizó un estudio descriptivo, transversal y retrospectivo de 40 pacientes ingresados por ingestión accidental de una sustancia cáustica en el Hospital Pediátrico Universitario de Centro Habana entre 1993 y 1998. Se observó que la ingestión de cáusticos fue más frecuente en varones de 1 a 4 años de edad. Los álcalis predominaron como sustancia ingerida y dominaron la sintomatología las lesiones orales, la sialorrea y la disfagia. En la mayoría de los pacientes se realizó la endoscopia a las 48 h y predominaron las lesiones de grado II y en el tercio medio. Un gran número de pacientes presentó complicaciones, entre las cuales la estenosis fue la más frecuente. En más de la mitad de los pacientes se emplearon medidas para neutralizar el cáustico y se aplicó tratamiento médico con antibióticos y esteroides

Deux cas de cancerisation des stenoses caustiques de l'oesophage

The incidence of carcinoma of the esophagus within patients with chronic esophageal stricture caused by ingestion of corrosive agents is reported to be significantly higher than in the general population. Two patients developed carcinoma of the esophagus respectively 25 and 40 years after corrosive injury. One of these patients had initially gastrostomy and repeated esophagal dilation. Taking into account the high incidence of carcinoma in the site of esophageal stricture, we conclude that the resection of the esophagus is indicated in patients with chronic caustic stricture if there is any finding suggestive of malignancies such as a long duration of the lesions more than 20 years particulary when the ingested agent was caustic soda or sudden aggravation of preexisting dysphagia

Clinical features of corrosive ingestion.

OBJECTIVE: To study the clinical presentation after corrosive ingestion. SETTING: A University Hospital. DESIGN: Prospective descriptive study. PATIENTS AND METHOD: Corrosive ingestion patients were studied, from July 2000 to December 2002. Reasons for ingestion, symptoms, physical findings and routine investigations were recorded in a standard form. Data analysed using the descriptive statistical method. RESULTS: There were 73 patients, 55 women and 18 men, median age 22 years, 48 (65.8%) of whom had ingested strong acid, 3 (4.1%) ingested strong alkali. Suicidal gesture was the most common reason for ingestion (89.2%). The amount of ingestion was less in accidental cases. Symptoms of nausea/vomiting, drooling and abdominal tenderness were associated with the amount of ingestion, while severity of lips, buccal mucosa and palate injuries was significantly related with strong corrosive agents (p < 0.05). Leucocytosis was found in patients who had symptoms of drooling, hoarseness, stridor and signs of mucosal slough or superficial ulcers (p < 0.05). Four required surgery. Two of them had esophago-gastrectomy. Twenty-one patients were followed-up, with the median follow-up time of 11 (1-28) months. One patient died from HIV infection. The rest were normal. CONCLUSION: Drooling and oral mucosal slough or ulcers were significant findings and were related to the amount and strength of the corrosive substance ingested, respectively. To meet the goal of a holistic approach, attention must also be given to psychiatric management, and surgeons should provide a supportive role.

Is there a difference between the management of grade 2b and 3 corrosive gastric injuries?

OBJECTIVE: To evaluate the differences between treatment of patients with grade 2b or grade 3 gastric injuries. SETTING: A University Hospital. DESIGN: Retrospective review. PATIENTS: Thirty patients who ingested caustic agents over a 5 year period were examined by endoscope within 48 hours of injury. RESULT: Twenty one patients ingested strong acid or alkali. Among these patients, five had grade 2b, and two had grade 3 injuries. In both cases of grade 3 injuries, extensive surgical approach was initially performed, then delayed jejunal and colonic interpositions were done. On the other hand, one 2b patient had exploratory laparotomy, while others were treated conservatively. All 2b patients had satisfactory conditions during the initial follow-ups. Three patients were healthy during the 11, 16, and 44 months follow-up, one developed chronic gastritis at 5 months and one patient failed to follow-up. CONCLUSION: Early and aggressive extensive removal of necrotic tissue is necessary and can certainly increase the survival. There is on going controversy in the management of injuries less than grade 3. Grade 2b gastric injury patients can be managed conservatively.

Quemaduras por agentes químicos / Chemical burns

Se realiza una revisión de la literatura nacional e internacional sobre quemaduras químicas. En primer término se describen las causas, la fisiopatología de las quemaduras y se presenta una clasificación de los compuestos químicos corrosivos que al ponerse en contacto con la piel general quemaduras químicas. Se destacan los ácidos inorgánicos, ácidos orgánicos, compuestos alcalinos y compuestos específicos que, por la naturaleza y gravedad de las lesiones que producen, requieren de una presentación individual, tales como el fósforo y el tetracloruro de titanio. A continuación se describen las medidas generales iniciales de tratamiento para toda quemadura química y algunas medidas especiales para corrosivos específicos de alta peligrosidad. Luego se definen las medidas de tratamiento local secundario. Por último, se incluye un párrafo especial para el manejo de las quemaduras oculares por agentes corrosivos. Al cierre, se destaca la necesidad de desarrollar una política educativa de prevención en el manejo de productos corrosivos como el mejor método par reducir la incidencia de lesiones graves

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.