Esophageal Injury Secondary to Caustic Ingestion

What is a caustic ingestion?

A caustic ingestion, which is a medical emergency, occurs when a child ingests a toxic substance.  This is often a household cleaning material or laundry detergent. There are two forms of caustic ingestion- an alkaline agent or an acidic agent- this is determined by the pH of the substance.

Examples of Toxic substances in the household:

  • Common household cleaning products such as oven or drain cleaners.
  • Laundry detergent pods are often ingested as they are colorful and attract the attention and curiosity of the child.
  • Hair relaxers.

Age group most at risk: Toddlers and Preschool age children.

Symptoms:

  • Choking or difficulty swallowing
  • Vomiting or the vomiting of blood
  • Bleeding from the mouth
  • Abdominal pain or chest pain
  • Respiratory distress

Treatment:  A caustic ingestion or suspicion of one is a medical emergency

  • Often the child will need EGD-Upper endoscopy to evaluate the extent of the damage to the esophagus or stomach.
  • Respiratory support may be needed if upper airway is injured.

Risks of Caustic Ingestion:

The amount of the toxic material ingested is often small but the degree of injury can still be great.

Complications:

  • Severe swelling of the mouth, throat or esophagus.
  • Upper airway injury or respiratory distress.
  • Necrosis of the mouth, throat, esophagus or stomach.
  • The long term complications of caustic ingestion include loss of esophageal motility, esophageal stricture or stenosis.
  • Gastric injury is less common in children since they usually do not ingest an amount large enough to reach the stomach.

 

Visual Effects:

 

Severe lip and edema ulceration.

Caustic Ingestion 14

 

Severe tongue burn and swelling.

Caustic Ingestion 16

 

Severe uvula and edema swelling.

Caustic Ingestion 123

 

Extensive circumferential necrosis and stenosis of the whole esophagus. 

Caustic Ingestion 17