Üst Gastrointestinal Sistemin Kostik Madde Yaralanmaları
Özet
Kostik madde yaralanmaları, özellikle düşük sağlık hizmetine sahip gelişmekte olan ülkelerde yüksek insidansa sahip ciddi bir halk sağlığı sorunudur. Kazara veya intihar amaçlı maruziyetler sonucu oluşan bu yaralanmalar, üst gastrointestinal ve solunum yollarında ağır kimyasal yanıklara yol açar. Maddenin ciddiyetini pH, tür ve miktar belirlerken; alkaliler sıvı formda kolay yutulup likefaksiyon nekrozuyla derin dokulara nüfuz eder, asitler ise koagülasyon nekrozu oluşturur. Akut evrede iskemi, mukozal hasar ve perforasyon riski yüksek olup, geç komplikasyonlar arasında disfajiye neden olan striktürler ve özofagus kanseri yer alır. Tanıda endoskopi ilk 12-24 saatte altın standarttır; bilgisayarlı tomografi ve baryumlu grafiler de hasarı değerlendirmede kullanılır. Akut yönetimde kusturma ve lavaj gibi uygulamalardan kaçınılmalı, havayolu açıklığı sağlanarak yaralanma derecesine göre tedavi planlanmalıdır. Grade III yaralanmalarda parenteral beslenme ve antibiyotik desteği gerekir. Darlıkların primer tedavisinde buji veya balon dilatasyonları uygulanırken, dirençli olgularda stent ve cerrahi müdahale zorunludur. Korunmada toplumsal bilinçlenme en etkili yoldur.
Caustic injuries present a major global public health concern, with higher incidence rates in developing countries due to lower healthcare standards. Resulting from accidental or suicidal ingestion, these substances cause severe chemical burns in the upper gastrointestinal and respiratory tracts. The severity depends on the pH, type, and volume; while acids lead to coagulation necrosis, alkalis cause liquefaction necrosis, penetrating deeper into tissues. The acute phase involves risks of ischemia, mucosal injury, and perforation, whereas long-term complications include strictures causing dysphagia and esophageal carcinoma. Upper endoscopy remains the gold standard for diagnosis within the first 12-24 hours, while computed tomography and barium studies help evaluate injury depth. Acute management strictly prohibits induced vomiting or gastric lavage, focusing on airway maintenance and stabilization. Patients with Grade III injuries require parenteral nutrition and antibiotics. Endoscopic bougie or balloon dilations are the primary treatment for strictures, but surgery or stenting becomes mandatory in refractory cases. Preventive measures and raising public awareness are the most effective ways to avoid these devastating injuries.
Referanslar
De Lusong MAA, Timbol ABG, Tuazon DJS. Management of esophageal caustic injury. World J Gastrointest Pharmacol Ther. 2017;8:90–98.
Hashmi MU, Ali M, Ullah K, Aleem A, Khan IH. Clinico-epidemiological characteristics of corrosive ingestion: a cross-sectional study at a tertiary Care hospital of Multan, South-Punjab Pakistan. Cureus. 2018;8:2704.
Sabzevari A, Maamouri G, Kiani MA, et al. Clinical and endoscopic findings of children hospitalized in Qa’em Hospital of Mashhad due to caustic ingestion (2011-2013) Electron Physician. 2017;9:4248–4250.
Mrazová K, Navrátil T, Pelclová D. Consequences of ingestions of potentially corrosive cleaning products, one-year follow-up. Int J Electrochem Sci. 2012;7:1734–1748.
Arevalo-Silva C, Eliashar R, Wohlgelernter J, et al. Ingestion of caustic substances: a 15-year experience. Laryngoscope 2006; 116:1422-6.
Haller JA, Andrews HG, White JJ, Tamer MA, Cleveland WW. Pathophysiology and management of acute corrosive burns of the esophagus: results of treatment in 285 children. J Pediatr Surg. 1971;8:578–584.
Kasap E, Özütemiz AÖ. Pet şişedeki tehlike: Korozif özofajit. Güncel Gastroenteroloji 2006;10(1):29-35.
Poley JW, Steyerberg EW, Kuipers EJ, Dees J, Hartmans R, Tilanus HW, Siersema PD. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc. 2004;60:372–377.
Gen T, Choichi S, Christopher G, et al. Clinical evaluation and management of caustic injury in the upper gastrointestinal tract in 95 adult patients in an urban medical center. Surg Endosc 2008; 22:1119–1125
Carmen C, Mirce´a C, Ce´cile de C, et al. Caustic injuries of the upper digestive tract: a population observational study. Surg Endosc 2012; 26:214–221
Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, Liu NJ, Chen PC. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol. 2008;25:31.
Han Y, Cheng QS, Li XF, Wang XP. Surgical management of esophageal strictures after caustic burns: a 30 years of experience. World J Gastroenterol. 2004;10:2846–2849.
Satar S, Topal M, Kozaci n. ıngestion of caustic substances by adults. Am j Ther. 2004;11:258-61.
Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of corrosive acids. Spectrum of injury to upper gastrointestinal tract and natural history. Gastroenterology. 1989;97:702–707
Havanond C. Is there a difference between the management of grade 2b and 3 corrosive gastric injuries? J Med Assoc Thai. 2002;85:340–344.
Mamede RC, de Mello Filho FV. Ingestion of caustic substances and its complications. Sao Paulo Med J. 2001;119:10–15.
Osman M, Russell J, Shukla D, Moghadamfalahi M, Granger DN. Responses of the murine esophageal microcirculation to acute exposure to alkali, acid, or hypochlorite. J Pediatr Surg. 2008;43:1672–1678.
Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991;37:165–169.
Mutaf O, Genç A, Herek O, Demircan M, Ozcan C, Arikan A. Gastroesophageal reflux: a determinant in the outcome of caustic esophageal burns. J Pediatr Surg. 1996;31:1494–1495.
Bautista A, Varela R, Villanueva A, Estevez E, Tojo R, Cadranel S. Motor function of the esophagus after caustic burn. Eur J Pediatr Surg. 1996;6:204–207.
Günel E, Cağlayan F, Cağlayan O, Akillioğlu I. Reactive oxygen radical levels in caustic esophageal burns. J Pediatr Surg. 1999;34:405–407.
Christesen HB. Diagnostic and treatment of caustic ingestion. Ugeskr Laeger. 1994;158:4125–4126.
Salzman M, O’Malley RN. Updates on the evaluation and management of caustic exposures. Emerg Med Clin North Am. 2007;25:459–476.
Korolev MP, Fedorov LE. Treatment of patients with combined burn stricture of the esophagus and stomach. Vestn Khir IM II Grek. 2005;164:70–72.
Chaudhary A, Puri AS, Dhar P, Reddy P, Sachdev A, Lahoti D, Kumar N, Broor SL. Elective surgery for corrosive-induced gastric injury. World J Surg. 1996;20:703–706; discussion 706.
Gumaste VV, Dave PB. Ingestion of corrosive substances by adults. Am J Gastroenterol. 1992;87:1–5.
Haller JA, Andrews HG, White JJ, Tamer MA, Cleveland WW. Pathophysiology and management of acute corrosive burns of the esophagus: results of treatment in 285 children. J Pediatr Surg. 1971;6:578–584.
Park KS. Evaluation and management of caustic injuries from ingestion of acid or alkaline substances. Clin Endosc. 2014;47:301-7.
Rigo GP, Camellini L, Azzolini F, Guazzetti S, Bedogni G, Merighi A, Bellis L, Scarcelli A, Manenti F. What is the utility of selected clinical and endoscopic parameters in predicting the risk of death after caustic ingestion? Endoscopy. 2002;34:304–310.
Cheng YJ, Kao EL. Arterial blood gas analysis in acute caustic ingestion injuries. Surg Today. 2003;33:483–485.
Katzka DA. Caustic Injury to the Esophagus. Curr Treat Options Gastroenterol. 2001;4:59–66.
Chiu HM, Lin JT, Huang SP, Chen CH, Yang CS, Wang HP. Prediction of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy. Gastrointest Endosc. 2004;60:827–833.
Kamijo Y, Kondo I, Kokuto M, Kataoka Y, Soma K. Miniprobe ultrasonography for determining prognosis in corrosive esophagitis. Am J Gastroenterol. 2004;99:851–854.
Peter M. Loeb, Abram M. Eisenstein. Caustic injury to the upper gastrointestinal tract. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 6th edition W.B. Saunders Company, 1998,335-42.
Lusong MAA, Timbol ABG, Tuazon DjS. Management of esophageal caustic injury. World j Gastrointest Pharmacol Ther. 2017;8(2):90-8.
Baskin D, Urganci N, Abbasoğlu L, Alkim C, Yalçin M, Karadağ C, Sever N. A standardised protocol for the acute management of corrosive ingestion in children. Pediatr Surg Int. 2004;20:824–828
Cakal B, Akbal E, Köklü S, Babali A, Koçak E, Taş A. Acute therapy with intravenous omeprazole on caustic esophageal injury: a prospective case series. Dis Esophagus. 2013;26:22-6
De Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: a 30-year review. Int J Pediatr Otorhinolaryngol 2001;57(3):203-11.
Riffat F, Cheng A. Pediatric caustic ingestion: 50 consecutive cases and a review of the literature. Dis Esophagus 2009;22(1):89- 94.
Hall AH, jacquemin D, Henny D, Mathieu L, josset P, Meyer B. Corrosive substances ingestion: a review. Critical Reviews in Toxicology. 2019;49(8):637-69.
Coronel G, De Lusong M. Sucralfate for the prevention of esophageal stricture formation in corrosive esophagitis: an open label, randomized controlled trial. Endoscopy. 2011;43 (Suppl 1):A42.
Méndez-nieto CM, Zarate-Mondragón F, Ramírez-Mayans j, FloresFlores M. Topical mitomycin C versus intralesional triamcinolone in the management of esophageal stricture due to caustic ingestion. Rev Gastroenterol Mex. 2015;80:248-54
Weigert A, Black A. Caustic ingestion in children. Contin Educ Anaesth Crit Care Pain 2005;5(1):5-8.
Katz A, Kluger Y. Caustic material ingestion injuries-paradigm shift in diagnosis and treatment. Health Care Current Reviews. 2015;3:1-4.
Nijhawan S, Udawat HP, nagar P. Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion. Dis Esophagus. 2016;29:1027-31.
Sandgren K, Malmfors G. Balloon dilatation of oesophageal strictures in children. Eur J Pediatr Surg. 1998;8:9–11.
Kochhar R, Ray JD, Sriram PV, et al. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc 1999; 49: 509-13.
Appignani A, Trizzino V. A case of brain abscess as complication of esophageal dilation for caustic stenosis. Eur J Pediatr Surg 1997; 7: 42-3.
Gupta v, Wig jD, Kochhar R, Sinha SK, nagi B, Doley RP, et al. Surgical management of gastric cicatrisation resulting from corrosive ingestion. ınt j Surg. 2009;7:257-61.
Ananthakrishnan N, Parthasarathy G, Kate V. Acute corrosive injuries of the stomach: a single unit experience of thirty years. ISRN Gastroenterol. 2011;2011:914013. doi: 10.5402/2011/914013.
McAuley CE, Steed DL, Webster MW. Late sequelae of gastric acid injury. Am J Surg. 1985;149:412–415
Tseng YL, Wu MH, Lin MY, Lai WW. Early surgical correction for isolated gastric stricture following acid corrosion injury. Dig Surg. 2002;19:276–280. doi: 10.1159/000064582.
Kochhar R, Sriram PV, Ray JD, Kumar S, Nagi B, Singh K. Intralesional steroid injections for corrosive induced pyloric stenosis. Endoscopy. 1998;30:734–736. doi: 10.1055/s-2007-1001400.
