title: Corrosive esophageal injuries in children. A shortlived experience in Sierra Leone.
abstract: OBJECTIVE
  Children with caustic ingestions in developing countries are often treated at home, sometimes by traditional healers, or are referred, frequently late, to tertiary hospitals, which only seldom offer adequate endoscopic and dilatation facilities. Therefore, when dilatations are performed, the stricture is often already well established, making dilatation more difficult. The aim of this paper is to report our experience in the management of corrosive injuries in a group of children of Sierra Leone, all complaining accidental ingestion of caustic soda, many of them treated months after the ingestion.
  
  
  METHODS
  We considered all children admitted after corrosive ingestion, from November 2001 to November 2005, to the "Emergency" Surgical Center in Goderich-Freetown, Sierra Leone. In December 2005 the hospital was supplied with endoscopes and dilatation devices. The children still followed up clinically were recalled to submit them to an endoscopic follow-up and to a dilatation, if needed.
  
  
  RESULTS
  Forty children were admitted (mean age: 4.5 years): 16 (group A) after an esophageal perforation during dilatation performed elsewhere (death rate: 56%). Twenty-four children (group B) were observed after ingestion, 58% being submitted to a surgical gastrostomy. Death rate after ingestion was nil. The mean interval between ingestion and endoscopy was 8.8 months. Fifty-three dilatations were carried out in 17 children over a 3 months period. We report three perforations (17.6%) and a death rate of 5.8% (1/17). Two patients were lost to follow-up. Three patients (17.6%) did not show any improvement. Four children complained recurrent dysphagia after the first dilatation cycle. Overall, 10 children (58.8%) showed a clear-cut improvement at 6 months.
  
  
  CONCLUSIONS
  The majority of treated strictures were late, therefore difficult to dilate and at higher risk of perforation. Dilatation with Savary bougies seems safer than with balloon catheters. Recurrent strictures and a long-term dilatation treatment should be expected. Retrograde dilatations through gastrostomies should be the preferred method of treatment and surgical gastrostomies should be performed without hesitation. Esophageal replacement is unlikely in these countries, except in very few referral centres. Therefore, any effort should be made to treat caustic strictures by timely dilatation programs.
authors: Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy. sandro.contini@unipr.it
authors: Sandro
authors: S
authors: Contini
authors: Makonnen
authors: M
authors: Tesfaye
authors: Piero
authors: P
authors: Picone
authors: Dario
authors: D
authors: Pacchione
authors: Beate
authors: B
authors: Kuppers
authors: Carlo
authors: C
authors: Zambianchi
authors: Carmelo
authors: C
authors: Scarpignato
mesh_terms: D000293:Adolescent; D002057:Burns, Chemical / Q000453:epidemiology* / Q000209:etiology*; D002404:Catheterization / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004940:Esophageal Stenosis / Q000503:physiopathology / Q000628:therapy; D004947:Esophagus / Q000187:drug effects* / Q000293:injuries* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012807:Sierra Leone / Q000453:epidemiology; D012972:Sodium Hydroxide / Q000009:adverse effects*
chemical_list: D012972:Sodium Hydroxide