Amanda Ngobese1,2, Saveshree Govender3,4, Nasheeta Peer5, Mahomed Hoosen Sheik-Gafoor3,4. 1. Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Street, Cato Manor, Durban, 4091, South Africa. ngobese_a@yahoo.com. 2. University of KwaZulu-Natal, Durban, South Africa. ngobese_a@yahoo.com. 3. Department of Paediatric Surgery, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Street, Cato Manor, Durban, 4091, South Africa. 4. University of KwaZulu-Natal, Durban, South Africa. 5. Non-communicable Diseases Research Unit, South African Medical Research Council, Durban, South Africa.
Abstract
PURPOSE: Considering that clinical presentation and gastrointestinal tract (GIT) injuries post-caustic ingestion vary in children, this study aims to establish whether a correlation exists between clinical presentation and endoscopic findings. METHODS: This retrospective study comprised patients referred to a paediatric surgical unit between 2016 and 2018 within 72 h post-caustic ingestion. Data collected included caustic agents ingested, clinical presentation, endoscopic findings and management. Oesophageal injuries were graded according to the Zargar's endoscopic classification and gastric injuries classified as mild to severe. RESULTS: Fifty patients with a mean age of 2.4 years were managed during the study period. Potassium permanganate (KMNO4) was the most frequently ingested substance in 27 (54%) patients. All 30 (60%) asymptomatic patients had no positive endoscopic findings regardless of clinical signs. Among the symptomatic patients (n = 20), 15 (75%) had oesophageal injuries (p = 0.01). Stridor was associated with a higher grade of oesophageal injury (p = 0.007). CONCLUSIONS: Clinical signs and symptoms post-caustic ingestion correlated with endoscopic findings in our study. Endoscopy can be safely omitted in asymptomatic patients, including those with isolated staining secondary to KMNO4 ingestion. Symptomatic patients should have an endoscopy performed within 48-72 h of the insult to diagnose injuries.
PURPOSE: Considering that clinical presentation and gastrointestinal tract (GIT) injuries post-caustic ingestion vary in children, this study aims to establish whether a correlation exists between clinical presentation and endoscopic findings. METHODS: This retrospective study comprised patients referred to a paediatric surgical unit between 2016 and 2018 within 72 h post-caustic ingestion. Data collected included caustic agents ingested, clinical presentation, endoscopic findings and management. Oesophageal injuries were graded according to the Zargar's endoscopic classification and gastric injuries classified as mild to severe. RESULTS: Fifty patients with a mean age of 2.4 years were managed during the study period. Potassium permanganate (KMNO4) was the most frequently ingested substance in 27 (54%) patients. All 30 (60%) asymptomatic patients had no positive endoscopic findings regardless of clinical signs. Among the symptomatic patients (n = 20), 15 (75%) had oesophageal injuries (p = 0.01). Stridor was associated with a higher grade of oesophageal injury (p = 0.007). CONCLUSIONS: Clinical signs and symptoms post-caustic ingestion correlated with endoscopic findings in our study. Endoscopy can be safely omitted in asymptomatic patients, including those with isolated staining secondary to KMNO4 ingestion. Symptomatic patients should have an endoscopy performed within 48-72 h of the insult to diagnose injuries.
Authors: Yoram Kluger; Ofir Ben Ishay; Massimo Sartelli; Amit Katz; Luca Ansaloni; Carlos Augusto Gomez; Walter Biffl; Fausto Catena; Gustavo P Fraga; Salomone Di Saverio; Augustin Goran; Wagih Ghnnam; Jeffry Kashuk; Ari Leppäniemi; Sanjay Marwah; Ernest E Moore; Miklosh Bala; Damien Massalou; Chirica Mircea; Luigi Bonavina Journal: World J Emerg Surg Date: 2015-10-16 Impact factor: 5.469