sodium-hypochlorite and Esophageal-Stenosis

Alkaline ingestion is a potentially life-threatening problem that may confront the emergency physician. It is similar to many other toxins in that children and those who attempt suicide are its most common victims; however, implications in terms of initial stabilization and definitive care are quite distinct. Mucosal exposure to lye results in a quick, deep liquefactive necrosis. Consequently, blind nasotracheal intubation may result in the perforation of damaged tissues in the pharynx and trachea. For similar reasons, the blind passage of a nasogastric tube is contraindicated. The use of diluents in this setting is controversial. If a diluent is used, water and milk are considered the liquids of choice. They may be used to irrigate oropharyngeal burns, but are contraindicated in the face of respiratory compromise, shock, liquid lye ingestion, and perforation of the esophagus or stomach. Cathartics and charcoal are not used after alkaline ingestion. Cathartics, however, are used in miniature alkaline battery ingestions to diminish bowel transit time. Esophagoscopy should be done within 12 to 24 hours after ingestion to directly observe the extent of damage. This procedure should be stopped at the first sign of injury to protect against iatrogenic esophageal perforation. Steroids should be started for circumferential esophageal burns and in those patients with significant injury who are unable to undergo esophagoscopy. IV antibiotics are administered for gastrointestinal perforation and may be used concomitantly with steroids. Miniature alkaline batteries lodged in the esophagus must be removed immediately. The available modalities include fluoroscopy-directed Foley catheter removal, endoscopy, and surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Burns, Chemical; Caustics; Charcoal; Child; Child, Preschool; Emergencies; Emetics; Endoscopy; Esophageal Stenosis; Esophagoscopy; First Aid; Gastric Mucosa; Gastroscopy; Household Products; Humans; Infant; Intestinal Mucosa; Lye; Methylprednisolone; Middle Aged; Sodium Hypochlorite; Therapeutic Irrigation

The severity of alkaline esophagitis due to sodium hypochlorite ingestion is variable and the findings of endoscope within 48 hours of ingestion are reported to be associated with its prognosis. We report a good recovery case of grade 2B of alkaline esophagitis, which was treated with close observation. The patient was 59-year old man. He was found lying on the bed by his wife, after drinking bactericidal agents (Jianok) and kitchen cleaner (Magiclean) for suicide attempt. After his trachea was intubated, he underwent upper gastrointestinal scope, which displayed circumferential ulcers at the lower esophagus. He was diagnosed as having a Grade 2B alkaline esophagitis, which was associated with a higher probability of stricture or perforation. On the 14th day of the admission, the 2nd endoscope was performed and no esophageal strictures were detected. He was extubated and started oral feeding on the 15th day. After that, his hospital course was uneventful and was discharged on the 18th day. 6 months have passed since he left hospital. No esophageal strictures were detected so far.

Topics: Esophageal Stenosis; Esophagitis; Esophagoscopy; Humans; Male; Middle Aged; Sodium Hypochlorite; Suicide, Attempted; Time Factors; Treatment Outcome

The aim of the study was to determine whether early esophagoscopy is really necessary for the patients who have ingested a corrosive agent. Patients who were followed up with the diagnosis of corrosive ingestion in our clinic between the years 1998 and 2008 were studied retrospectively. The data were collected through the medical records of the patients and from interviews with them. The analyzed parameters included age, gender, the nature and the amount of the ingested agent, whether the event was accidental or suicidal, diagnostic tools, treatment and the results of the treatment, and long-term follow up. Over a 10-year period, a total of 124 cases of corrosive ingestion cases were determined. Of these, 64 (51.6%) were male and 60 (48.4%) were female. The mean age was 38 +/- 17.5 years. The most commonly ingested corrosive agents were sodium hypochlorite in 50 (40.3%) patients and hydrochloric acid in 33 (26.6%) patients. The mean admission time for the emergency department after ingestion of the corrosive agent was 2.5 +/- 3.7 hours. Ingestion was accidental in 82% of the patients and as a result of a suicide attempt in 18%. The amount of ingested corrosive agent in the suicidal group (190 +/- 208.3 mL) was higher than that of accidental group (66 +/- 58.3 mL) (P= 0.012). Nine patients underwent esophagoscopy, six of which were performed in other clinical centers. Only three (2.4%) patients experienced esophageal stricture, which were treated with repeated dilatations. In the long-term follow up, we could get in touch with only 63 patients and none of them had complications due to corrosive ingestion. The follow-up period ranged from 1 to 120 months (median 45 +/- 29.2 months). Based on our study, early esophagoscopy appears to be unnecessary in adult patients who ingested the corrosive agent accidentally. A larger prospective study is needed to answer the question.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Burns, Chemical; Caustics; Esophageal Diseases; Esophageal Stenosis; Esophagoscopy; Female; Humans; Hydrochloric Acid; Male; Middle Aged; Retrospective Studies; Sodium Hypochlorite; Unnecessary Procedures; Young Adult

Caustic products are responsible for the most serious cases of poisoning, which are always emergency cases. Application of current intervention procedures has decreased both morbidity and mortality. Water-diluted bleach, the ingestion of which remains extremely frequent, is a moderate irritant rather than a caustic product. Emission of gas produced when mixing bleach with other agents can be responsible for choking gas poisoning. Anionic and nonionic detergents are mostly dangerous because of their foam-producing properties. Mercury vapours and methanol are other potentially hazardous products.

Topics: Acute Disease; Adult; Aged; Burns, Chemical; Caustics; Child; Detergents; Esophageal Stenosis; Household Products; Humans; Middle Aged; Poisoning; Sodium Hypochlorite; Stomach

A retrospective study was done on corrosive oesophageal burns to ascertain the preventive effect of corticosteroids on stricture development. Within the last 12 years 351 children were admitted to our medical centre with a history of corrosive agent ingestion. In 235 of these the diagnosis of oesophageal burn was confirmed by means of oesophagoscopy. Children admitted within the first 48 hours received steroid, antibiotic and fluid therapy while fluid and antibiotics were given, if needed, in the rest. Forty-six of the children were lost to follow-up. The type of corrosive agent, the admission period, the degree of the burn and the stricture development were used as parameters. Stricture development was found statistically significant in late admitted patients vs. early admissions. This retrospective study suggests the effectiveness of corticosteroid treatment in preventing the stricture development.

Topics: Acetates; Adrenal Cortex Hormones; Burns, Chemical; Child; Esophageal Stenosis; Humans; Hydrochloric Acid; Nitrates; Retrospective Studies; Sodium Hydroxide; Sodium Hypochlorite; Sulfuric Acids; Time Factors

In this paper we describe the use of circular myotomies to approximate the oesophageal ends resulting from resection of an oesophageal stricture due to ingestion of domestic bleach. This procedure has spared the child from major oesophageal surgery with its known morbidity. This is the second case described using this method from this institute.

Topics: Barium Sulfate; Burns, Chemical; Child, Preschool; Esophageal Stenosis; Esophagoplasty; Female; Follow-Up Studies; Humans; Postoperative Complications; Radiography; Sodium Hypochlorite

Controversial therapeutic issues in patients with caustic ingestions concern the reliability of symptoms and signs in predicting esophageal injury, the appropriate use of endoscopy in evaluating esophageal damage, and the use of steroids in preventing late strictures. The conclusions of this review are: The majority of pediatric caustic ingestions involve a "lick and taste" whereas adolescents and adults often ingest substantial quantities. Oral burns and dysphagia are sensitive predictors of esophageal injury; however, esophageal injury may occur in the absence of the findings. Household bleach and nonphosphate detergents represent a low risk of injury whereas button batteries greater than 20 mm in diameter and Clinitest tablets represent high risk. Endoscopy should be an elective rather than emergency procedure and should be undertaken in all symptomatic patients, and in asymptomatic patients when history indicates substantial ingestion. Steroid therapy should be considered only for patients who have deep or circumferential esophageal burns.

Topics: Acids; Adolescent; Adult; Alkalies; Animals; Burns, Chemical; Caustics; Child; Child, Preschool; Citrates; Citric Acid; Copper Sulfate; Detergents; Drug Combinations; Electric Power Supplies; Endoscopy; Esophageal Stenosis; Esophagus; Household Products; Humans; Mice; Radiography; Sodium Bicarbonate; Sodium Hypochlorite; Steroids

Topics: Adult; Biopsy; Burns, Chemical; Child, Preschool; Esophageal Stenosis; Female; Humans; Intestinal Mucosa; Radiography; Sodium Hypochlorite

Topics: Burns; Burns, Chemical; Caustics; Child; Eating; Esophageal Stenosis; Esophagoscopy; Humans; Sodium Hypochlorite; Toxicology