Acid ingestion in pediatric population; negligence to be compensated with lifelong morbidity.

Dear Editor,

Acid ingestion in pediatric population is not very uncommon in developing countries even in the twenty-first century. Negligence of parents’ toward acid handling at home is a major concern. The lack of legislation for acid manufacturer and free availability in open market also contribute to this. We are presenting a case of acid ingestion with its grave consequences.

The laparotomy finding of a 3-year-old male child was very unfortunate, the stomach was completely split opened and three-fourth of the stomach along the greater curvature was necrosed completely [Figure 1]. The child presented in poor condition with history of accidental acid ingestion (stored in a soft drink bottle) three days back.

Figure 1

Stomach along the greater curvature (white arrow) necrosed completely

During operation, necrosed part of the stomach was excised and lesser curvature which seemed viable was converted into a tube and brought out as end gastrostomy, the distal duodenal end was closed [Figure 2]. Finally, the child recovered well after a stormy postoperative course but he will require a major reconstructive procedure later.

Figure 2

Gastric tube made by viable lesser curvature (black arrow) which was brought out as end gastrostomy and the distal duodenal (white arrow) end was closed

Children are more prone to acid injury because:

Negligence of parents towards acid handling,

Availability of acid without safety mechanism,

Storage of acid in soft drink or colourful bottles are tempting, and

Curiosity of children especially toddler to put anything into the mouth.

Corrosive ingestion requires surgical intervention in case of perforation of the esophagus (can lead to tracheoesophageal fistula), may require immediate esophagectomy with resultant cervical esophagostomy and gastrostomy. Perforation of the stomach or duodenum (may lead to peritonitis, shock, and death) requires immediate operation and further reconstructive surgeries later.[123]