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Chemical burns of the esophagus
Last reviewed: 27.11.2021
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Chemical burns of the esophagus occur with the accidental or deliberate ingestion of caustic liquids, which exert a coagulating and denaturing effect on the proteins of the esophagus and stomach tissues, which leads to their destruction. The legal interpretation defines these lesions either as an accident or as a suicidal attempt. The direct action of caustic liquid on the esophagus and stomach does not lead to death, but their consequences can lead to severe morphological lesions of these organs and deep disability, and the resulting after-burn perforations of the esophagus and stomach - to the most severe inflammatory processes in the mediastinum and abdominal cavity, often with fatal.
The cause of chemical burns of the esophagus. Most often, chemical burns of the esophagus are caused by ingestion of acids (acetic, hydrochloric, sulfuric, nitric) or alkalis (potassium hydroxide, sodium hydroxide). According to VO Danilov (1962), sodium hydroxide burns are more common (98 cases out of 115). According to Romanian authors, children under 7 years old (43.7%), children aged 7 to 16 years old - 9.1%, children aged 7 to 16 years - 9.1%, from 16 to 30 years - 25.8%, the remaining 21.4% fall to the older age. Most often, chemical burns of the esophagus arise as a result of an accident (all victims under 16 years old, after 16 years - in 78.2% of cases). Intentional use of caustic liquid (the same morphologically and most severe) among the total number of victims is 19.3%, of which for ages from 16 to 30 years, 94.2% among women and 5.8% among men.
Chemical burn of the esophagus - Causes and pathogenesis
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.
Chemical burn of the esophagus - Symptoms
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.
Chemical burn of the esophagus - Diagnosis
Treatment of chemical burns of the esophagus. The tactics of treatment are determined by the stage of the lesion, its clinical form, the time of first aid, or the arrival of the injured person to the emergency room or the hospital that has passed since the poisoning, the amount, concentration and type of caustic liquid (acid, alkali, etc.).
According to the terms of medical care, the treatment of chemical burns of the esophagus is divided into the acute stage (between the 1 st and 10 th day after the burn), early in the subacute stage or before the stage of stricture formation (10-20 days) and later with chronic post-burn esophagitis (after 30 days).
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