Chemical burn of the esophagus: diagnosis

Diagnosis of chemical burns of the esophagus does not cause difficulties (anamnesis, residual caustic liquid in the corresponding container, characteristic "bucco-pharyngo-esophagal" 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 it is even more difficult to foresee the complications and The consequences that may result from this trauma.

After providing the first urgent care to the patient and removing him from the shock state, which is usually achieved on the 2nd day after the incident, the patient undergoes fluoroscopy with contrasting with a water-soluble drug. In the acute stage this method can detect areas of reflex spasm of the esophagus, with deep burns - mucosal defects. In the chronic stage with the developing cicatricial process, the stricture region is clearly defined and above it - the beginning dilatation 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 lesion sites reached their maximum development and the process of repair began: localized edema, granulation tissue covering the ulcers, and diffuse edema practically disappeared. The production of esophagoscopy at an earlier time threatens perforation of the esophagus, especially at its entrance. In the chronic stage, which can conventionally be called the stage of recovery, with EsSk in the region of the resulting stricture, a funnel-shaped narrowing with rigid rigid walls of whitish color is defined. With older strictures, the esophagus is defined above them.

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

In the chronic stage of chemical burns of the esophagus differential diagnosis is 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, myxomes, hemangiomas) are rare and the dysphagic syndrome develops very slowly, for many months and years. The general condition worsens gradually and in the 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 with the help of esophagoscopy and biopsy.

Malignant tumors of the esophagus are more often benign and are characterized by a more significant and rapidly advancing dysphagic syndrome against a background of general deterioration of the body's condition (weight loss, anemia, hemorrhages, etc.). Diagnosis of malignant tumors of the esophagus does not cause difficulties, because both radiological and video endoscopically, and biopsy establish typical (pathognomonic) signs of these diseases.

In the differential diagnosis of chemical burns of the esophagus in later stages, one should keep in mind such diseases as functional spasms, esophageal expansion and paralysis, gum or tubercular lesions of its esophagus, parasitic and fungal diseases, scleroderma, diverticula and primary ulcer of the esophagus, diaphragmatic hernia, compression esophagus localized outside its voluminous pathological processes (mediastinal lymphadenitis, aortic aneurysm, metastatic tumors, etc.), as well as Plummer-Vin syndrome it.

The prognosis for chemical burns of the esophagus is always doubtful due to the weakness of the esophagus wall, the possibility of numerous complications and the formation of scar stricture. In the past, lethality with chemical burns of the esophagus reached 40% or more. At present, the use of antibiotic therapy and other early treatment methods has made it possible to reduce the lethality with chemical burns of the esophagus to 2.5-3%. Out of this number, about 70% of deaths occur in thoracoabdominal complications and 30% in general-afferent and toxic kidney and liver lesions.

[1], [2], [3], [4], [5], [6], [7]