Chemical burns of the esophagus

Chemical burns of the esophagus occur when caustic liquids are accidentally or intentionally swallowed, which have a coagulating and denaturing effect on the proteins of the tissues of the esophagus and stomach, which leads to their destruction. Legal interpretation defines these injuries as either an accident or a suicide attempt. Direct exposure of the caustic liquid to the esophagus and stomach does not lead to death, but their consequences can lead the victim to severe morphological damage to these organs and to profound disability, and the resulting post-burn perforations of the esophagus and stomach - to severe inflammatory processes in the mediastinum and abdominal cavity, often with a fatal outcome.

Causes of chemical burns of the esophagus. Most often, chemical burns of the esophagus are caused by swallowing acids (acetic, hydrochloric, sulfuric, nitric) or alkalis (potassium hydroxide, sodium hydroxide). According to V.O. Danilov (1962), sodium hydroxide burns are most common (98 cases out of 115). According to Romanian authors, children under 7 years of age are most often affected (43.7%), 9.1% between the ages of 7 and 16, 9.1% between the ages of 7 and 16, 25.8% between the ages of 16 and 30, and the remaining 21.4% are at an older age. Most often, chemical burns of the esophagus occur as a result of an accident (all victims under 16; after 16 - in 78.2% of cases). Intentional consumption of a caustic liquid (which is also morphologically the most severe) accounts for 19.3% of the total number of victims, of which 94.2% are women and 5.8% are men aged 16 to 30 years.

Chemical burn of the esophagus - Causes and pathogenesis

The symptoms and clinical course of chemical burns of the esophagus are closely related to the dynamics of pathological changes in the affected sections of the esophagus and the time that has passed since the caustic liquid entered it. In the debut stage, corresponding to the acute pathological stage, symptoms of acute esophagitis are observed. In the latent, or "light" stage, symptoms of subacute esophagitis are observed. In the chronic stage, symptoms of chronic esophagitis dominate.

The acute stage is characterized by a dramatic clinical picture: sharp burning pain in the mouth, pharynx, esophagus and epigastric region; cough or temporary respiratory arrest due to spasm of the larynx, vomiting with an admixture of blood depending on the liquid taken: brown or black in case of alkali poisoning, greenish (hydrochloric acid), yellowish (nitric acid). The patient rushes about, instinctively rushes to the water tap to wash the burning liquid out of the mouth, wheezes, there is an expression of indescribable fear on the face, clutches the throat and chest with his hands. The most favorable phenomenon in all this symptomatology is vomiting, which may result in the expulsion of part of the swallowed liquid. After some time (1/2-1 hour), difficulty swallowing or complete inability to do so, hoarseness or complete loss of voice, general weakness, severe thirst, small and frequent pulse appear. In such cases, collapse and death often occur within a few hours.

Chemical Burn of the Esophagus - Symptoms

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.

Chemical burn of the esophagus - Diagnostics

Treatment of chemical burns of the esophagus. The tactics of treatment measures are determined by the stage of the lesion, its clinical form, the time of first aid or the arrival of the victim at the emergency room or hospital, elapsed since the poisoning, the amount, concentration and type of caustic liquid (acid, alkali, etc.).

Based on the time frame for providing medical care, treatment of chemical burns of the esophagus is divided into emergency treatment at the acute stage (between the 1st and 10th day after the burn), early treatment at the subacute stage or before the stage of stricture formation (10-20 days), and late treatment for chronic post-burn esophagitis (after 30 days).

Chemical Burn of the Esophagus - Treatment

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