Our experience with caustic oesophageal burn in South of Iran

Abstract

Context: The alkaline oesophageal burn (EB) is a very debilitating injury  and common in the southern rural area of Iran, where the air conditioning systems are cleaned with an alkaline liquid, which is accidentally ingested by children.
Aims: The aim is to share our experiences with caustic injury in children.
Settings and Design: A ‘before’ and ‘after’ clinical trial.
Materials and Methods: From November 2006-2009, 35 cases of alkaline burns were referred to our center. All underwent flexible endoscopy and thereafter received steroid, antibiotic and H2 blocker. They subsequently
underwent rigid oesophagoscopy, with grade IIb or higher burns, for  inserting the two different kinds of stents.
Results: Four out of 10 (GIIa <) underwent dilatation occasionally. Fifteen (GIIb) with early large stent (eight weeks) developed complications (three antral contractures, one oesophagotracheal fistula, one tracheobronchial fistula, three perforations, three deaths, and the remaining cases had not undergone dilatation yet. Four out of 10 with (GIIb), who had small stents (Six months) and early gastrostomy needed dilatation every four to six weeks and all recovered, with no significant complications.
Conclusions:Early use of gastrostomy prevents malnutrition in patients. Small size stents are much more tolerable for a prolonged time are not obstructed by saliva that washes the wall of the damaged oesophagus continuously and promotes healing.