Caustic ingestion

• Published in: The Lancet (British edition) Vol. 389; no. 10083; pp. 2041 - 2052
• Main Authors: Chirica, Mircea, Dr, Bonavina, Luigi, Prof, Kelly, Michael D, MS, Sarfati, Emile, Prof, Cattan, Pierre, Prof
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 20-05-2017; Elsevier Limited
• Subjects: Acids; Burns; Burns, Chemical - diagnostic imaging; Burns, Chemical - therapy; Caustics - toxicity; Computed tomography; Digestive system; Digestive System Surgical Procedures; Disease Management; Emergency medical care; Endoscopy; Esophageal Stenosis - chemically induced; Esophageal Stenosis - diagnostic imaging; Esophageal Stenosis - therapy; Esophagus; Hazardous materials; Humans; Implants; Ingestion; Injuries; Injury prevention; Internal Medicine; Lifesaving; Necrosis; Ostomy; Practice Guidelines as Topic; Public health; Stents; Stomach; Stomach - injuries; Stricture; Surgical implants; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Watchful Waiting; India
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(16)30313-0

Summary Corrosive ingestion is a rare but potentially devastating event and, despite the availability of effective preventive public health strategies, injuries continue to occur. Most clinicians have limited personal experience and rely on guidelines; however, uncertainty persists about best clinical practice. Ingestions range from mild cases with no injury to severe cases with full thickness necrosis of the oesophagus and stomach. CT scan is superior to traditional endoscopy for stratification of patients to emergency resection or observation. Oesophageal stricture is a common consequence of ingestion and newer stents show some promise; however, the place of endoscopic stenting for corrosive strictures is yet to be defined. We summarise the evidence to provide a plan for managing these potentially life-threatening injuries and discuss the areas where further research is required to improve outcomes.