[INGESTION OF CORROSIVE SUBSTANCES]
Every patient that ingests any caustic substance still constitutes a medical and surgical. The severity and extension of the chemical damage will basically depend on the concentration and quantity of the caustic substance ingested. Likewise, when a highly concentrated alkali or acid substance is ingested, the esophagus and stomach will be damaged, and this lesion could also spread to the duodenum, and in some cases to the jejunum. Furthermore, it may compromise adjacent organs with a high morbimortality. The severity degree of the lesion can be determined with no risk by a flexible endoscopy, and correlates well with the intensity of tissue damage, enabling us to decide the manner in which this lesion is to be handled, with a prognosis value. A superficial grade (1 or 2a),will require no treatment and it will evolve without sequela. However, upon the determination of deep, ulcerated circumferential lesions, or with necrotic fundus by endoscopy (Grade 2b, and 3), patients shall be hospitalized and shall receive enteral or parenteral nutrition, as well as antibiotic protection. Careful attention should be given due to the risk of perforation or hemorrhage, and ocasionally, urgent surgical treatment will be necessary.The use of corticosteroids has proved to be innefective in preventing stenosis and is potentially dangerous. The most frequent late sequela is the developing of esophageal stenosis (developing in 50-70% of the 2b, and in all of the 3 who survive), and antral stenosis. The esophageal stenosis are tributaries of dilatations with bougies. An option to avoid stenosis, specially in children, is the placement of short plastic tubes, temporarily. In cases where there is no good response to the dilatations. or when the stenosis are long and multiple, surgery with interposition of colon or jejunum will be necessary. Usually, the development of gastric stenosis requires surgery. Motor alterations and gastroesophageal reflux as sequela may also be present, and belatedly, a greater risk to develoop squamous cancer.
Contardo
Carlos
C