Morbidity and Mortality of Corrosive Injury of Esophagus : A Study of 50 Cases

Abstract

Objective: To evaluate the morbidity and mortality of corrosive injury of esophagus. Introduction: Corrosive ingestion, mostly accidental in children and with suicidal or deliberate self-harm intention in adults, still remains a prevalent condition in developing countries. It is relatively common among the illiterate people having poor socioeconomic condition residing in the rural areas. It poses a great challenge to the otorhinolaryngologist from management point of view. Study design: Descriptive study. Place and duration of study: This study was conducted in the department of ENT and Head & Neck Surgery, Allied Hospital (PMC) Faisalabad during a period of two years from November 2013 to October 2015. Patients and Methods: Fifty patients with history of corrosive ingestion were included in the study. All patients were admitted in the ENT department and thoroughly investigated regarding history, physical examination and investigations according to a written proforma. Inclusion criteria: The patients of either sex ranging from 3 years to 60 years, having history of corrosive ingestion and giving written consent for any surgical intervention and regular follow up were included in the study. Exclusion criteria: Patients having age below 3 years and above 60 years, patients with malignant stricture, peptic stricture and not giving written consent for surgical intervention and regular follow up were excluded. Data analysis: SPSS software version 20 was used to analyze the data. Results: Out of 50 patients, 16% were males and 84% were females ranging from 3 years to 60 years.  Thirty one patients (62%) were from rural areas while 19 patients (38%) were urban dwellers. Forty one patients (82%) took acid whereas 9 patients (18%) took alkali. Eleven patients (22%) reported early within first three days of corrosive intake while 39 patients (78%) reported late. Two patients out of 50 were received in very serious condition with respiratory distress and shock who died despite of emergency treatment. Endoscopic examination of 48 survivors showed grade I corrosive injury in 6 patients (12.5%), grade II injury in 30 patients (62.5%) and grade III injury in 12 patients (25%). Forty two patients were found to develop esophageal strictures. Thirty four patients (81%) out of 42 had single stricture while 08 patients (19%) had multiple strictures who were referred to general surgery for further management. Treatment: Patients having minor burns were successfully managed conservatively and no stricture was found in 6 months follow up period. Patients with single stricture were managed with endoscopic dilation with good results while patients having multiple strictures of esophagus were referred to general surgery for further management. Conclusion: Stricture formation in the esophagus and resulting dysphagia is more frequently seen in those patients who present late after corrosive ingestion. Moreover endoscopic dilatation of corrosive induced strictures with gum elastic bougies is quite safe and effective procedure to relive dysphagia although repeated sessions of endoscopic dilatations are often required.