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Caustic Injury

Caustic Injury. By H.Salehinia. The swallowing of caustic substances causes an acute and a chronic injury

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Caustic Injury

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  1. Caustic Injury By H.Salehinia

  2. The swallowing of caustic substances causes an acute and a chronic injury • In the acute phase, the degree and extent of the lesion are dependent on several factors: the nature of the caustic substance, its concentration, the quantity swallowed, and the time the substance is in contact with the tissues

  3. Alkalies dissolve tissue, and therefore penetrate more deeply, while acids cause a coagulative necrosis that limits their penetration.

  4. Clinical Manifestations • The clinical picture of an esophageal burn is determined by the degree and extent of the lesion. • In the initial phase, complaints consist of pain in the mouth and substernal region, hypersalivation, pain on swallowing, and dysphagia. The presence of fever is strongly correlated with the presence of an esophageal lesion.

  5. Of the patients who develop strictures, 60% do so within 1 month, and 80% within 2 months. If dysphagia does not develop within 8 months, it is unlikely that a stricture will occur

  6. Early esophagoscopy is advocated to establish the presence of an esophageal injury. • Radiographic examination is not a reliable means to identify the presence of early esophageal injury, but is important in later follow-up to identify strictures.

  7. Endoscopic Grading of Corrosive Esophageal and Gastric Burns • First degree: Mucosal hyperemia and edema • Second degree: Limited hemorrhage, exudate ulceration, and pseudomembrane formation. • Third degree: Sloughing of mucosa, deep ulcers, massive hemorrhage, complete obstruction of lumen by edema, charring, and perforation

  8. Treatment • Neutralizing agents • Sodium bicarbonate is not used . • Emetics are contraindicated. • Steroids

  9. Esophagoscopy(12h) 1 burn 2 & 3 burn observation Exploratory 24 – 48 h laparatomy viable Questionable Full necrosis - Stent -Second look -Esophagogastric -P.Gas.BX at 36 h resection -Jejunostomy -Cervical esophagostomy -Jejunostomy -Resection of adjacent involved organs

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