Caustic ingestion in children: a prospective study in 64 cases

ABSTRACT

In a 2 year period, 64 children with caustic ingestion were prospectively studied. The ingested agents were bleach in 41 patients, caustic soda in 13, strong acids in 8 and Savlon in 2. The injury was assessed within 48 hours of ingestion by fiberoptic endoscopy of the whole esophagus, stomach and duodenum in all patients. Grade 0 [normal] was seen in 43 patients, grade 1 in one, grade 2a in 11, grade 2b in 5 and grade 3 in 4 patients. No significant burn was found after ingestion of bleach. Signs and symptoms were unreliable in predicting the severity of injury. Those with grade 2 or 3 burn received corticosteroid, antibiotic and antacid. Only 3 cases [16.6%] developed esophageal stricture; one improved with esophageal dilation, the other two needed colonic interposition. It is concluded that a] Endoscopy is safe and indicated after caustic ingestion but could be withheld in asymptomatic patients after ingestion of bleach. b] Corticosteroids when used with antibiotics are safe and may have a role in prevention of stricture formation. c] Early prophylactic esophageal replacement is not indicated even in severe burn without perforated viscus, since most cases recover without sequelae