Chemical burn of the esophagus: symptoms

Symptoms and clinical course of chemical burns of the esophagus are closely related to the dynamics of pathoanatomical changes in the affected parts of the esophagus and the time that has passed since the ingestion of a caustic liquid. In the debut stage corresponding to the acute pathoanatomical stage, the symptoms of acute esophagitis are observed. In the latent, or the stage of the "light" gap, symptoms of subacute esophagitis are observed. In the chronic phase, the symptoms of chronic esophagitis predominate.

The acute stage is characterized by a dramatic clinical picture: a sharp burning pain in the mouth, pharynx, esophagus and epigastric region; coughing or temporary respiratory arrest due to spasm of the larynx, vomiting with an admixture of blood depending on the fluid taken: brown or black for alkali poisoning, greenish (hydrochloric acid), yellowish (nitric acid). The patient rushes, instinctively rushes to the tap to wash the burning fluid from the mouth, wheeze, on the face - an expression of indescribable fear, grabs his hands in the throat, chest. The most favorable phenomenon in all of this symptomatology is vomiting, at which the part of the swallowed fluid can be erased. After a while (1 / 2-1 h) there is difficulty in swallowing or complete inability, hoarseness or complete loss of voice, general weakness, severe thirst, small and frequent pulse. In such cases, in a few hours, collapse and death often occur.

With this clinical form, characterized as severe, signs of traumatic (pain) shock, which arose as a result of sharp stimulation of pain receptors in the oral cavity, pharynx and esophagus, dominate. In the future, the clinical picture is determined by the toxigenic action of catabolites of tissue proteins destroyed by a poisonous substance. The victim is pale, languid, blood pressure is lowered, tachycardia, breathing frequent shallow, lips cyanotic, pupils dilated. The shock state can progress, and the patient dies within a few days.

Due to numerous chemical burns of the lips, mouth and throat, the patient experiences severe burning pain in these areas, while the esophagus causes deep pain behind the breastbone, in the epigastric region or in the interblade area. Of the other signs that characterize the severe clinical form of chemical burns of the esophagus, one should note a high body temperature (39-41 ° C), bloody vomiting, melena and oliguria with albuminuria. With non-fatal poisoning and appropriate treatment, the general condition of the patient gradually improves, the affected parts of the mucosa of the esophagus are restored and after 12-20 days the patient begins to eat independently. Of the complications of severe form should be noted bronchopneumonia, mediastinitis, peritonitis, etc. With total dysphagia and sharp soreness when swallowed impose gastrostomy.

Light and moderate clinical course in the acute period is much more common. General and local symptoms are less pronounced. After a painful and dysphagic phase lasting 8-10 days, the patient begins to eat independently, while it is necessary to restrain his inordinately large appetite and offer sparing food.

The subacute stage (the stage of false recovery) is characterized by a sluggish course, the disappearance of pain. Patients begin to eat almost in full, their body weight and overall good condition are quickly restored. This stage is dangerous because, despite the apparent recovery, the tissues of the esophagus are undergoing scarring and stricture formation. At this stage, patients often refuse further treatment, believing that a full recovery has occurred. However, after a while they begin to have difficulty in swallowing food, first dense, then semi-liquid, and finally, liquid. And the esophageal syndrome returns, and the process passes into the third, chronic, stage.

The chronic stage of after-burn esophagitis is characterized by a prolonged progressive course as a local fibrotic process leading to cicatricial stenosis of the esophagus and to its supraclural dilatation, as well as the general state of the organism characterized by general exhaustion, weight loss, and the appearance of signs of alimentary dystrophy. Dysphagia reappears usually 30-60 days after the incident. The final formation of cicatricial post-burn stenosis of the esophagus is completed by the end of the third month after the injury, but there are cases of the final formation of stricture and after 6 months.

The main sign of esophageal stricture in this phase is the eructation of undigested food and saliva, which can appear immediately after a meal or 2-3 hours later. A constant sign is the progressive weight loss of a patient whose degree depends on the diameter of the remaining lumen of the esophagus in the stricture area. Usually, with moderate strictures, the patient loses up to 20-30 kg for 2-3 months, reaching cachexia by 4-5 months.

Complications of chemical burns of the esophagus are divided into early, or immediate, developing within 1-3 days, and late, arising in the chronic stage. The early complications include swelling of the larynx and trachea, leading to difficulty breathing and even to asphyxia, bronchopneumonia, spontaneous or instrumental perforation, pereezophagitis, mediastinitis, hemorrhages. Later complications are caused by the appearance of scar stricture and infection. In the presence of cicatricial stenosis in the area of hypofarings and entering the esophagus, dyspnea, asphyxia, dysphagia and aphagia occur. Strictures throughout the esophagus cause over it its dilatation, which maintains its chronic inflammation. Strictures create favorable conditions for the introduction in them of foreign bodies or fragments of dense food products, which leads to obstruction of the esophagus and the occurrence of food blockages. Late spontaneous or buzz-provoking esophageal perforations lead to the appearance of mediastinitis, pericarditis, pleurisy, and lung abscess.

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