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Corrosive Esophageal Injuries

Corrosive esophageal injuries are a major concern and are quite common in children. But, some of the cases are accidental too. The esophagus gets corroded due to the intake of any substance that has the properties of corroding flesh. In adults, there have been suicidal cases of corrosive esophageal injuries. People often ingest alkali or acid which results in excessive corrosion of the esophagus which becomes life-threatening.

What are the types of corrosive esophageal injuries?

Corrosive esophageal injuries can result either due to alkaline ingestions or acidic ingestions. But the mechanism of their action is different.

  • When a person ingests alkaline substances, it results in corrosion by a process known as liquefactive necrosis. This process involves the denaturation of proteins along with saponification of fats. The cellular membranes get disrupted. This disruption makes way for the alkaline substances to get into the layers of mucosa that are present deep down. Thrombosis of small vessels also occurs alongside these disruptions. Alkaline substances which have a pH greater than 11 lead to very serious damage. When the alkaline substance is in a liquid form, it can travel a long way down the oesophagus and cause distal injuries.
  • When a person ingests acid substances, it results in corrosion by a process known as coagulative necrosis. This type of necrosis leads to the formation of eschar. But the eschar that forms stops the spread of the acidic substance deep into the esophagus. Thus, the eschar functions to save the esophagus from getting deeply burnt. But, on the other hand, the acid travels down and accumulates in the stomach leading to gastric perforation.

What substances lead to corrosive esophageal injuries?

  • Alkaline substances
    • Sodium hydroxide is one of the most commonly ingested alkaline substance. It is present in the soaps commonly used in your household and even drain cleaners.
    • Sodium carbonate is another alkaline compound that is present in soaps and is also used in fruit drying in farms.
    • Potassium hydroxide is present in oven cleaners and also in washing powders.
  • Acidic Substances
    • Sulphuric acid is one of the commonly ingested acidic substances present in batteries, metal plating, and certain industrial cleaning agents.
    • Oxalic acid is present in metal cleaners and paint thinners.
    • Hydrochloric acid is present in toilet cleaners and several solvents.
  • Detergent
    The sodium polyphosphate or sodium hypochlorite content of detergents lead to corrosion and is present in household bleach and cleaners.

What are the treatment options for corrosive esophageal injuries?

When a person is detected with a corrosive esophageal injury, the first priority should be airway monitoring. If any problem is found with the airway, then the establishment of a definitive airway should be done. To understand the grade to which the injury has occurred an EGD or esophagogastroduodenoscopy should be done. If the pediatric patients can ingest normal food, then they can be released with certain medications. Surgery should be opted if there is a report of any significant perforation.

You must take the patient to the doctor immediately after you find out that they have ingested some caustic substance.

Authored By Dr G Parthasarathy - Surgical Gastroenterologist, Hyderabad