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ESOPHAGUS
Alkaline
Liquefaction necrosis and results in a
deep burn
Esophageal injury more severe
More frequently swallowed accidentally
than acid due to less burning pain
Acid
Coagulative necrosis and results in
forming an eschar that limits tissue
penetration
Gastric injury more severe due to pyloric
spasm
PATHOLOGICAL PHASE
1. Acute necrotic or initial phase
: 1-4 days post injury
: inflammatory reaction & tissue necrosis
: pain in the mouth & substernum
PATHOLOGICAL PHASE
2. Ulceration & granulation phase
: subacute or latent phase
: 3-5 days post injury & last 10-12 days
: tissue necrosis & tissue sloughs result in
mucosal defect, inflamed base and filling
granulation tissue
: weakest esophagus
PATHOLOGICAL PHASE
3. Cicatrization & scarring phase
: begins the third week following injury
: contracting connective tissue &
narrowing esophagus
: stricture formation
CLINICAL MANIFESTATIONS
Initial complaints consist of pain in the mouth
and substernal region & pain on swallowing
Hypersalivation, fever, bleeding vomitus
Initial complaints disappear during latent phase
Dysphagia reappears during scarring phase,
60% within 1 month and 80% within 2 months
If no dysphagia within 8 months, no stricture will
occur
CLINICAL MANIFESTATIONS
Serious systemic reaction such as
hypovolumia and acidosis
Renal damage caused by strong acids
Respiratory complication such as
laryngospasm or edema or aspirated
pneumonia
CLINICAL MANIFESTATIONS
Oropharyngeal examination
Esophageal burns can be present without
symptoms or evidence of oropharyngeal
burns
Early esophagoscopy is recommended
12-24 hours post injury & the scope should
not be introduced beyond the proximal
esophageal lesion to assess severity for
treatment plan
ENDOSCOPIC GRADING OF
CAUSTIC INJURY
Grade 1 : superficial mucosal hyperemia
Grade 2A : superficial ulcer
Grade 2B : deep ulcer or circumferential
ulcer
Grade 3A : focal necrosis & eschar
Grade 3B : extensive necrosis & eschar
RADIOGRAPHIC EXAMINATION
Not reliable means for early injury
Early : water soluble contrast for suspicious
perforation
Late : barium swallow in later follow up to
identify strictures
MANAGEMENT OF STRICTURES
Optimal time for dilation is 3- 4 weeks post injury
Pre-dilation esophagogram
Antegrade dilation
Tucker retrograde dilation
Goal : up to 42- 44F but accept 36-38F
Frequency: severe q 2 wk
mild to moderate q 3- 4 wk
Duration: 6-12 months
SUMMARY MANAGEMENT OF
ACUTE
CAUSTIC INJURY
SUMMARY MANAGEMENT OF
ACUTE
Grade 1 ,2ACAUSTIC INJURY
: 48 hr observation
: NPO, advance diet as tolerated
: worsening symptom treat as 2B,3
Grade 2B ,3A
: NPO, antibiotics, PPI, ICU observation
: deterioration emergency resection