Chemical burns of the esophagus - Diagnosis

The diagnosis of chemical burns of the esophagus is not difficult (anamnesis, remnants of caustic liquid in the appropriate container, characteristic "bucco-pharyngo-esophageal" syndrome and other clinical signs of a general nature). It is much more difficult to establish the degree of the burn, its prevalence and depth, and even more difficult to foresee the complications and consequences that may arise as a result of this injury.

After providing first aid to the patient and bringing him out of the state of shock, which is usually achieved on the 2nd day after the incident, the patient undergoes fluoroscopy with a water-soluble contrast agent. In the acute stage, this method can detect areas of reflex spasm of the esophagus, and in the case of deep burns - defects of the mucous membrane. In the chronic stage, with the developing cicatricial process, the area of stricture is clearly defined and above it - the beginning dilation of the esophagus and, possibly, another area of scarring of its wall.

Esophagoscopy is performed only after the acute stage, between the 10th and 14th day of the disease, when the affected areas have reached their maximum development and the reparation process has begun: localized edema, granulation tissue covering the ulcers, and diffuse edema have practically disappeared. Performing esophagoscopy at an earlier stage threatens perforation of the esophagus, especially at its entrance. In the chronic stage, which can be conditionally called the recovery stage, with EsSc in the area of the forming stricture, a funnel-shaped narrowing with rigid, immobile, whitish walls is determined. With old strictures, an expansion of the esophagus is determined above them.

Differential diagnostics in the absence of clear anamnestic data and information about the circumstances of the "disease" (for example, residues of caustic liquid, containers from it, witness testimony, etc.) encounters certain difficulties and is carried out with a fairly large number of diseases, including banal primary and secondary esophagitis and specific diseases of the esophagus. The difference between banal esophagitis is that the duration of the acute period is significantly shorter than with chemical burns of the esophagus, there are no signs of a chemical burn in the oral cavity and pharynx, and the symptoms are determined by the clinical and anatomical form of esophagitis - catarrhal, ulcerative or phlegmonous. Specific esophagitis occurs as a complication against the background of a general infectious disease, the diagnosis of which in most cases is already known (diphtheria, typhus, scarlet fever, secondary syphilis). In addition to the above-mentioned diseases, chemical burns of the esophagus in the acute stage should be differentiated from allergic esophagitis, as well as from spontaneous ruptures of the esophagus in alcoholics. Both diseases occur suddenly, and allergic esophagitis is characterized by concomitant allergic phenomena on the mucous membrane of the pharynx and oral cavity, itching, burning, glassy edema of the entrance to the larynx, and spontaneous ruptures of the esophagus are characterized by sudden severe "dagger" pain in the epigastric region with tension of the muscles of the abdominal wall, rapid development of periesophagitis, mediastinitis and pleurisy.

In the chronic stage of chemical burns of the esophagus, differential diagnostics are carried out with benign and malignant tumors of the esophagus. It should be borne in mind that almost all benign tumors of the esophagus (cysts, fibromas, papillomas, rhabdomyomas, lipomas, myxomas, hemangiomas) are rare and dysphagic syndrome develops very slowly, over many months and years. The general condition worsens gradually and over years from the onset of the disease and does not reach such severity as in the chronic stage of chemical burns of the esophagus, manifested by its cicatricial stenosis. The diagnosis of benign diseases is established using esophagoscopy and biopsy.

Malignant tumors of the esophagus are more common than benign tumors and are characterized by a more significant and rapidly developing dysphagic syndrome against the background of a general deterioration in the body's condition (weight loss, anemia, hemorrhages, etc.). Diagnosis of malignant tumors of the esophagus does not cause difficulties, since typical (pathognomonic) signs of these diseases are established by radiography, video endoscopically, and biopsy.

In the differential diagnosis of chemical burns of the esophagus in the late stages, one should keep in mind such diseases as functional spasms, dilations and paralysis of the esophagus, gummatous or tuberculous lesions of its wall, parasitic and fungal diseases, scleroderma, diverticula and primary ulcerative disease of the esophagus, diaphragmatic hernia, compression of the esophagus by localized external volumetric pathological processes (mediastinal lymphadenitis, aortic aneurysm, metastatic tumors, etc.), as well as Plummer-Vinson syndrome.

The prognosis for chemical burns of the esophagus is always questionable due to the fragility of the esophageal wall, the possibility of numerous complications and the formation of cicatricial stricture. In the past, the mortality rate for chemical burns of the esophagus reached 40% or more. Currently, the use of antibiotic therapy and other early treatment methods has reduced the mortality rate for chemical burns of the esophagus to 2.5-3%. Of this number, about 70% of deaths are due to thoracoabdominal complications and 30% to general resorptive and toxic damage to the kidneys and liver.

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