A 4-year-old boy is seen 1 h after ingestion of a lye drain

Discussion in 'MRCS Forum' started by Lona., Aug 3, 2008.

  1. Lona.

    Lona. Guest

    A 4-year-old boy is seen 1 h after ingestion of a lye drain cleaner. No oropharyngeal burns are noted, but the patient’s voice is hoarse. Chest x-ray is normal. Of the following, which is the most appropriate therapy?
    a- Immediately Esophagoscopy
    b- Parenteral steroids and antibiotics
    c- Administration of an oral neutralizing agent
    d- Induction of vomiting
    e- Rapid administration of a quart of water to clean remaining lye from the esophagus and dilute material in stomach

    Answer: b. (Schwartz, 7/e, pp 1158-1161) Corrosive injuries of the esophagus most frequently occur in young children due to accidental ingestion of strong alkaline cleaning agents. Significant esophageal injury occurs in 15% of patients with no oropharyngeal injury, while 70% of patients with oropharyngeal injury have no esophageal damage. Signs of airway injury or imminent obstruction warrant close observation and possibly tracheostomy. The risk of adding injury, particularly in a child, makes Esophagoscopy contraindicated in the opinion of most surgeons. Administration of oral antidotes is ineffective unless given within moments of ingestion; even then, the additional damage potentially caused by the chemical reactions of neutralization often makes use of them unwise. A barium esphagogram is usually done within 24 h unless evidence of perforation is present. In most reports, steroids in conjunction with antibiotics reduce the incidence of formation of strictures from about 70% to about 15%. Vomiting should be avoided, if possible, to prevent further corrosive injury and possible aspiration. It is probably wise to avoid all oral intake until the full extent of injury is ascertained.

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