Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and ...Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developingcountries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.展开更多
Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries.One of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-sys...Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries.One of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-system derangements.Patient’s Concern:A 41-year-old male patient presented with complaints of throat discomfort,severe generalized abdominal pain,and multiple episodes of hematemesis after ingesting a restroom cleaning solution.Diagnosis:Poisoning by acute caustic ingestion(containing<30%phosphoric acid and<4%ethylene glycol).Interventions:The patient was administered 50 mL of 8.4%sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h,a hyperkalemia kit,ceftriaxone,metronidazole,omeprazole,and atropine.The patient then underwent urgent hemodialysis.Outcomes:The patient suffered gastrointestinal bleeding as a result of local caustic injury.In addition,his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes(hyperphosphatemia,hyperkalemia,and hypocalcemia).He developed multi-organ failure and eventually demised.Lessons:The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion.These patients need to be monitored closely for deterioration,and have prompt management of the various arising complications,to reduce the high morbidity and mortality associated with this condition.展开更多
Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its gro...Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and p H of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.展开更多
Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Althoughthe caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable r...Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Althoughthe caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable role in diagnosis and treatment. Endoscopy can determine the severity of caustic ingestion which is of great importance in choosing appropriate treatment. However, some aspects of endoscopy in diagnosis of caustic injury remain controversial. Whether or not all patients need endoscopy, when to perform endoscopy and how to assess the severity are just some examples of these controversies. Due to lack of randomized controlled trials, many findings and suggestions are inconclusive. Computerized tomography scan of the chest and abdomen gains popularity in assessing the severity of caustic injury and avoiding unnecessary surgery. If esophageal stricture eventually develops, endoscopic dilatation is a mainstay. Maneuvers such as steroid injection and esophageal stent may be used in a refractory stricture. Nevertheless, some patients have to undergo surgery in spite of vigorous attempts with esophageal dilatation. To date, caustic injury remains a difficult situation. This article reviews all aspects of caustic injury of the esophagus focusing on endoscopic role. Pre-endoscopic management, endoscopy and its technique in acute and late phase of caustic injury including the endoscopic management of refractory stricture, and the treatment outcomes following each endoscopic intervention are thoroughly discussed. Finally, the role of endoscopy in the long term follow-up of patients with esophageal caustic injury is addressed.展开更多
Background: Management of post-corrosive esophageal strictures represents a major challenge for clinicians. There are many options for treatment as dilatation alone or dilatation with injection of corticosteroids, ste...Background: Management of post-corrosive esophageal strictures represents a major challenge for clinicians. There are many options for treatment as dilatation alone or dilatation with injection of corticosteroids, stent placement, and surgery. The aims of the study: This is a retrospective study to assess the success rate of different treatment modalities for post-corrosive esophageal stricture including: endoscopic dilatation, stenting or surgery and to define any complications. Methods: Clinical and endoscopic data for patients with post-corrosive esophageal stricture admitted to the endoscopy unit between September 2012 and September 2017 were collected. Retrospective analysis of data was done to detect the types of treatment, success rate and any detectable complications. Results: A total of 50 patients with their ages ranged between 3 and 20 years were included in this study. Male patients represented 54% (27 patients) and females were 23 (46%). The cause of caustic material ingestion was mainly accidental (47 patients, 94%) and only 3 patients were suicidal (6%). Dilatation was successful in most cases either with or without injection of corticosteroids (39 patients, 78%). Stenting was a good option in cases of refractory or recurrent dilatations (11 patients;22%) with excellent results. Surgery rarely needed (only in one patient) and only when dilatation and stenting failed. Conclusions: Endoscopic treatment of post-corrosive esophageal stricture has a good result and low rate of complications. The covered self-expandable metal stent (SEMS) is a good option in cases of refractory strictures, surgery rarely needed and after failure of previous modalities.展开更多
BACKGROUND Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARY We present a ca...BACKGROUND Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARY We present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt.He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit.The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest.Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.CONCLUSION The aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression.We aim to illustrate pitfalls in the endoscopic examination and provide further aware-ness on critical care monitoring and management strategies to reduce its morbidity and mortality.展开更多
BACKGROUND Aorto-oesophageal fistula(AOF)are uncommon and exceedingly rare after corrosive ingestion.The authors report a case of AOF after corrosive ingestion that survived.A comprehensive literature review was perfo...BACKGROUND Aorto-oesophageal fistula(AOF)are uncommon and exceedingly rare after corrosive ingestion.The authors report a case of AOF after corrosive ingestion that survived.A comprehensive literature review was performed to identify all cases of AOF after corrosive ingestion to determine the incidence of this condition,how it is best managed and what the outcomes are.CASE SUMMARY A previously healthy 30-year-old male,presented with a corrosive oesophageal injury after drain cleaner ingestion.He did not require acute surgical resection,but developed long-segment oesophageal stricturing,which was initially managed with cautious dilatation and later stenting.An AOF was suspected at endoscopy performed two months after the ingestion,when the patient represented with massive upper gastrointestinal bleeding.The fistula was confirmed on computerised tomographic angiography.The initial bleeding at endoscopy was temporised by oesophageal stenting;a second stent was placed when bleeding recurred later the same day.The stenting successfully achieved temporary bleeding control,but resulted in sudden respiratory distress,which was found to be due to left main bronchus compression caused by the overlapping oesophageal stents.Definitive bleeding control was achieved by endovascular aortic stent-grafting.A retrosternal gastroplasty was subsequently performed to achieve gastrointestinal diversion to reduce the risk of stent-graft sepsis.He was subsequently successfully discharged and remains well one year post injury.CONCLUSION AOF after corrosive ingestion is exceedingly rare,with a very high mortality.Most occur weeks to months after the initial corrosive ingestion.Conservative management is ill-advised.展开更多
Background:Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies(peptic or caustic inge...Background:Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies(peptic or caustic ingestion).The purpose of our work was to describe the experience of gastric transposition in three Italian centers.Methods:This is a retrospective study.The data were extrapolated from a prospective database.We included all patients who had undergone gastric transposition in the last 15 years.Results:In the 15-year period,eight infants and children(3 males and 5 females)underwent gastric transposition for esophageal replacement.Six patients had long-gap esophageal atresia,and two had caustic esophageal stenosis.There were no deaths in the series.Three patients had an early postoperative complication:two had a self-limited salivary fistula at three weeks,and one(a patient with jejunostomy)had a jejunal perforation treated surgically.One late complication,anastomotic stricture,was recorded that required two endoscopic dilatations.The median follow-up was 60 months(range:18–144 months).At final clinical follow-up,six patients had no eating problems,and two patients had some difficulties with eating(jejunostomy in situ),but they underwent logopedic therapy with improved outcomes.All patients had an increase in body weight and height postoperatively.Conclusion:Our small study reports the clinical experience of three Italian centers in which gastric transposition was performed with excellent results,both in terms of surgical technique(simplicity,reproducibility,complication rate)and clinical follow-up(good oral feeding of young patients,normal social life and regular growth curves).展开更多
Hydrogen peroxide is a common over-the-counter solution that has developed a growing body of literature regarding toxic ingestion. Intentional ingestion of high concentration hydrogen peroxide for health purposes has ...Hydrogen peroxide is a common over-the-counter solution that has developed a growing body of literature regarding toxic ingestion. Intentional ingestion of high concentration hydrogen peroxide for health purposes has gained popularity in certain patient populations; purported benefits are due to the increased oxygen released into the blood stream. We present for evaluation one such case with associated imaging that presented to our urban medical center. A brief review of the literature was also performed noting current recommendations regarding both outcomes and indications for endoscopy as well as hyperbaric oxygen therapy following ingestion of hydrogen peroxide. Our patient was a 51-year-old white female who presented with foamy hematemesis after ingesting 10 drops of 35% hydrogen peroxide as part of a home remedy to cleanse her colon and improve blood oxygenation. In addition to hematemesis,she also reported diffuse abdominal pain with sore throat and hoarse voice. Her imaging demonstrated portal venous gas and gastric edema. She was admitted for hyperbaric oxygen therapy and underwent upper endoscopy demonstrating diffuse esophagitis and gastritis with white exudate and multiple petechiae. She was later discharged home in stable condition and was lost to follow-up.展开更多
文摘Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developingcountries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
文摘Rationale:Acute caustic ingestion from suicidal intent is not usual in emergency departments in developed countries.One of the substances commonly ingested by suicidal patients,phosphoric acid,tends to cause multi-system derangements.Patient’s Concern:A 41-year-old male patient presented with complaints of throat discomfort,severe generalized abdominal pain,and multiple episodes of hematemesis after ingesting a restroom cleaning solution.Diagnosis:Poisoning by acute caustic ingestion(containing<30%phosphoric acid and<4%ethylene glycol).Interventions:The patient was administered 50 mL of 8.4%sodium bicarbonate solution followed by an isotonic sodium bicarbonate solution running at 500 mL/h,a hyperkalemia kit,ceftriaxone,metronidazole,omeprazole,and atropine.The patient then underwent urgent hemodialysis.Outcomes:The patient suffered gastrointestinal bleeding as a result of local caustic injury.In addition,his course of illness was complicated by severe acidemia from high anion gap metabolic acidosis and deranged electrolytes(hyperphosphatemia,hyperkalemia,and hypocalcemia).He developed multi-organ failure and eventually demised.Lessons:The clinician needs to be mindful of the multi-system complications arising from such a caustic ingestion.These patients need to be monitored closely for deterioration,and have prompt management of the various arising complications,to reduce the high morbidity and mortality associated with this condition.
文摘Ingestion of caustic substances and its long-term effect on the gastrointestinal system maintain its place as an important public health issue in spite of the multiple efforts to educate the public and contain its growing number. This is due to the ready availability of caustic agents and the loose regulatory control on its production. Substances with extremes of pH are very corrosive and can create severe injury in the upper gastrointestinal tract. The severity of injury depends on several aspects: Concentration of the substance, amount ingested, length of time of tissue contact, and p H of the agent. Solid materials easily adhere to the mouth and pharynx, causing greatest damage to these regions while liquids pass through the mouth and pharynx more quickly consequently producing its maximum damage in the esophagus and stomach. Esophagogastroduodenoscopy is therefore a highly recommended diagnostic tool in the evaluation of caustic injury. It is considered the cornerstone not only in the diagnosis but also in the prognostication and guide to management of caustic ingestions. The degree of esophageal injury at endoscopy is a predictor of systemic complication and death with a 9-fold increase in morbidity and mortality for every increased injury grade. Because of this high rate of complication, prompt evaluation cannot be overemphasized in order to halt development and prevent progression of complications.
文摘Caustic injury of the esophagus is a problematic condition challenging endoscopists worldwide. Althoughthe caustic agents and motives are different among countries and age groups, endoscopy still plays an invaluable role in diagnosis and treatment. Endoscopy can determine the severity of caustic ingestion which is of great importance in choosing appropriate treatment. However, some aspects of endoscopy in diagnosis of caustic injury remain controversial. Whether or not all patients need endoscopy, when to perform endoscopy and how to assess the severity are just some examples of these controversies. Due to lack of randomized controlled trials, many findings and suggestions are inconclusive. Computerized tomography scan of the chest and abdomen gains popularity in assessing the severity of caustic injury and avoiding unnecessary surgery. If esophageal stricture eventually develops, endoscopic dilatation is a mainstay. Maneuvers such as steroid injection and esophageal stent may be used in a refractory stricture. Nevertheless, some patients have to undergo surgery in spite of vigorous attempts with esophageal dilatation. To date, caustic injury remains a difficult situation. This article reviews all aspects of caustic injury of the esophagus focusing on endoscopic role. Pre-endoscopic management, endoscopy and its technique in acute and late phase of caustic injury including the endoscopic management of refractory stricture, and the treatment outcomes following each endoscopic intervention are thoroughly discussed. Finally, the role of endoscopy in the long term follow-up of patients with esophageal caustic injury is addressed.
文摘Background: Management of post-corrosive esophageal strictures represents a major challenge for clinicians. There are many options for treatment as dilatation alone or dilatation with injection of corticosteroids, stent placement, and surgery. The aims of the study: This is a retrospective study to assess the success rate of different treatment modalities for post-corrosive esophageal stricture including: endoscopic dilatation, stenting or surgery and to define any complications. Methods: Clinical and endoscopic data for patients with post-corrosive esophageal stricture admitted to the endoscopy unit between September 2012 and September 2017 were collected. Retrospective analysis of data was done to detect the types of treatment, success rate and any detectable complications. Results: A total of 50 patients with their ages ranged between 3 and 20 years were included in this study. Male patients represented 54% (27 patients) and females were 23 (46%). The cause of caustic material ingestion was mainly accidental (47 patients, 94%) and only 3 patients were suicidal (6%). Dilatation was successful in most cases either with or without injection of corticosteroids (39 patients, 78%). Stenting was a good option in cases of refractory or recurrent dilatations (11 patients;22%) with excellent results. Surgery rarely needed (only in one patient) and only when dilatation and stenting failed. Conclusions: Endoscopic treatment of post-corrosive esophageal stricture has a good result and low rate of complications. The covered self-expandable metal stent (SEMS) is a good option in cases of refractory strictures, surgery rarely needed and after failure of previous modalities.
文摘BACKGROUND Tracheo and broncho esophageal fistulas and their potential complications in adults are seldom encountered in clinical practice but carries a significant morbidity and mortality.CASE SUMMARY We present a case of a 39-year-old otherwise healthy man who presented to our hospital after ingestion of drain cleaner substance during a suicidal attempt.He unexpectedly suffered from cardiac arrest during his stay in the intensive care unit.The patient had developed extensive segmental trachea-broncho-esophageal fistulous tracks that led to a sudden and significant aspiration event of gastric and duodenal contents with subsequent cardiopulmonary arrest.Endoscopic evaluation of extension of fistulous track proved a slow and delayed progression of disease despite initial management with esophageal stenting for his caustic injury.CONCLUSION The aim of this case presentation is to share with the reader the dire natural history of trachea-broncho-esophageal fistulas and its delayed progression.We aim to illustrate pitfalls in the endoscopic examination and provide further aware-ness on critical care monitoring and management strategies to reduce its morbidity and mortality.
文摘BACKGROUND Aorto-oesophageal fistula(AOF)are uncommon and exceedingly rare after corrosive ingestion.The authors report a case of AOF after corrosive ingestion that survived.A comprehensive literature review was performed to identify all cases of AOF after corrosive ingestion to determine the incidence of this condition,how it is best managed and what the outcomes are.CASE SUMMARY A previously healthy 30-year-old male,presented with a corrosive oesophageal injury after drain cleaner ingestion.He did not require acute surgical resection,but developed long-segment oesophageal stricturing,which was initially managed with cautious dilatation and later stenting.An AOF was suspected at endoscopy performed two months after the ingestion,when the patient represented with massive upper gastrointestinal bleeding.The fistula was confirmed on computerised tomographic angiography.The initial bleeding at endoscopy was temporised by oesophageal stenting;a second stent was placed when bleeding recurred later the same day.The stenting successfully achieved temporary bleeding control,but resulted in sudden respiratory distress,which was found to be due to left main bronchus compression caused by the overlapping oesophageal stents.Definitive bleeding control was achieved by endovascular aortic stent-grafting.A retrosternal gastroplasty was subsequently performed to achieve gastrointestinal diversion to reduce the risk of stent-graft sepsis.He was subsequently successfully discharged and remains well one year post injury.CONCLUSION AOF after corrosive ingestion is exceedingly rare,with a very high mortality.Most occur weeks to months after the initial corrosive ingestion.Conservative management is ill-advised.
文摘Background:Esophageal replacement in children is an option that is confined to very few situations including long-gap esophageal atresia and esophageal strictures unresponsive to other therapies(peptic or caustic ingestion).The purpose of our work was to describe the experience of gastric transposition in three Italian centers.Methods:This is a retrospective study.The data were extrapolated from a prospective database.We included all patients who had undergone gastric transposition in the last 15 years.Results:In the 15-year period,eight infants and children(3 males and 5 females)underwent gastric transposition for esophageal replacement.Six patients had long-gap esophageal atresia,and two had caustic esophageal stenosis.There were no deaths in the series.Three patients had an early postoperative complication:two had a self-limited salivary fistula at three weeks,and one(a patient with jejunostomy)had a jejunal perforation treated surgically.One late complication,anastomotic stricture,was recorded that required two endoscopic dilatations.The median follow-up was 60 months(range:18–144 months).At final clinical follow-up,six patients had no eating problems,and two patients had some difficulties with eating(jejunostomy in situ),but they underwent logopedic therapy with improved outcomes.All patients had an increase in body weight and height postoperatively.Conclusion:Our small study reports the clinical experience of three Italian centers in which gastric transposition was performed with excellent results,both in terms of surgical technique(simplicity,reproducibility,complication rate)and clinical follow-up(good oral feeding of young patients,normal social life and regular growth curves).
文摘Hydrogen peroxide is a common over-the-counter solution that has developed a growing body of literature regarding toxic ingestion. Intentional ingestion of high concentration hydrogen peroxide for health purposes has gained popularity in certain patient populations; purported benefits are due to the increased oxygen released into the blood stream. We present for evaluation one such case with associated imaging that presented to our urban medical center. A brief review of the literature was also performed noting current recommendations regarding both outcomes and indications for endoscopy as well as hyperbaric oxygen therapy following ingestion of hydrogen peroxide. Our patient was a 51-year-old white female who presented with foamy hematemesis after ingesting 10 drops of 35% hydrogen peroxide as part of a home remedy to cleanse her colon and improve blood oxygenation. In addition to hematemesis,she also reported diffuse abdominal pain with sore throat and hoarse voice. Her imaging demonstrated portal venous gas and gastric edema. She was admitted for hyperbaric oxygen therapy and underwent upper endoscopy demonstrating diffuse esophagitis and gastritis with white exudate and multiple petechiae. She was later discharged home in stable condition and was lost to follow-up.
