title: Oesophageal corrosive injuries in children: a forgotten social and health challenge in developing countries.
abstract: OBJECTIVE
  An unsafe environment is a risk factor for child injury and violence. Among those injuries that are caused by an unsafe environment, the accidental ingestion of corrosive substances is significant, especially in developing countries where it is generally underreported.
  
  
  METHODS
  To address this challenging, unmet medical need, we started a humanitarian programme in Sierra Leone. By reviewing the current literature from developing countries and our own experience in the field, we developed a flowchart for management of this clinical condition.
  
  
  METHODS
  This injury is underreported in developing countries. Data available are heavily skewed towards well-resourced centres and do not reflect the entire reality of the condition. Late oesophageal strictures are usually severe. Parent's lack of knowledge, crowded living conditions and availability of chemicals in and around houses account for most ingestions. The widespread lack of any preventive measures represents the strongest risk factor.
  
  
  RESULTS
  Timely admission was observed in 19.5% of 148 patients studied. A gastrostomy was performed on 62.1% of patients, 42.8% had recurrent strictures and 19% are still on a continuous dilatation programme. Perforation and death rate were respectively 5.6% and 4%.
  
  
  CONCLUSIONS
  The majority of oesophageal caustic strictures in children are observed late, when dilatation procedures are likely to be more difficult and carry a significantly higher recurrence rate. Gastrostomy is necessary to maintain adequate nutritional status but mothers need training in feeding techniques. Both improvement in nutritional status and sustained oesophageal patency should be the reference points to a successful dilatation.
authors.affiliation: Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100, Parma, Italy. sandro.contini@unipr.it
authors.forename: Sandro
authors.initials: S
authors.lastname: Contini
authors.forename: Alim
authors.initials: A
authors.lastname: Swarray-Deen
authors.forename: Carmelo
authors.initials: C
authors.lastname: Scarpignato
mesh_terms: D000293:Adolescent; D002057:Burns, Chemical / Q000209:etiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D004940:Esophageal Stenosis / Q000139:chemically induced*; D004947:Esophagus / Q000293:injuries* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male
references.citation: Acta Paediatr. 1994 Feb;83(2):212-5
references.pmid: 8193505
references.citation: Bull Soc Pathol Exot. 2002 Mar;95(1):45-6
references.pmid: 12012964
references.citation: Int J Pediatr Otorhinolaryngol. 2007 Oct;71(10):1597-604
references.pmid: 17716749
references.citation: Gastrointest Endosc. 2008 Sep;68(3):434-9
references.pmid: 18448103
references.citation: Acta Paediatr. 1994 Nov;83(11):1200-5
references.pmid: 7841737
references.citation: Am J Emerg Med. 2005 Sep;23(5):589-666
references.pmid: 16140178
references.citation: Dig Liver Dis. 2009 Apr;41(4):263-8
references.pmid: 18801710
references.citation: Bull World Health Organ. 2000;78(11):1330-6
references.pmid: 11143193
references.citation: Bull World Health Organ. 2008 Jun;86(6):420
references.pmid: 18568265
references.citation: Lancet. 1997 May 3;349(9061):1269-76
references.pmid: 9142060
references.citation: Pediatr Surg Int. 1998 Jul;13(5-6):336-40
references.pmid: 9639611
references.citation: Trop Doct. 2002 Apr;32(2):78-80
references.pmid: 11933901
references.citation: Niger J Med. 2002 Oct-Dec;11(4):183-6
references.pmid: 12955997