Koroziv madde hasarlarının retrospektif olarak değerlendirilmesi

Year 2017, , 57 - 61, 23.11.2017

Seyit Uyar , Süleyman Dolu Mehmet Kök Gökhan Köker Mutlu Çatlı Feyzi Bostan Yasin Şahintürk Ayhan Hilmi Çekin

https://doi.org/10.17940/endoskopi.356836

Abstract

Giriş ve Amaç: Koroziv madde alımı çoğunlukla pediatrik popülasyonda yanlışlıkla içim sonrası görülse de, erişkin yaş grubunda da hala karşılaşılan bir durumdur. Oluşabilecek hasar içilen maddenin cinsi, miktarı ve mukoza ile temas süresi ile doğrudan ilgilidir. Hasarın erken tespit edilmesi tedavinin en önemli basamağıdır ve endoskopik görüntüleme bu konudaki en önemli yöntemdir. Biz bu çalışmada hastanemize başvurmuş olan erişkin yaş koroziv madde alımlarını retrospektif olarak değerlendirmek istedik. Gereç ve Yöntem: 01 Ocak 2008 ve 01 Temmuz 2017 yılları arasında koroziv madde alımı ile hastanemize başvuran, 18 yaş üstü 125 vaka çalışmaya dahil edildi. Hastaların endoskopik hasar derecesi 0-1-2 olanlar hafif, 3-4 olanlar ciddi hasar olarak değerlendirildi. İçilen maddeler özelliklerine göre asidik, alkali ve diğer olarak gruplandı.. Bulgular: 62 kadın, 63 erkek toplam 125 hastanın yaş ortalaması 39,3±15,1 yıl idi. 90 hastaya (%72) ilk 24-48 saat içinde endoskopi yapılmıştı. 95 hasta (%76) maddeyi yanlışlıkla, 30 hasta (%24) ise suisid amaçlı almıştı. 14 (14,7) hastada özofagus, 43 (%45,3) hastada mide ve 38 (%40) hastada mide ve özofagus beraber tutulmuştu. Hastaların 84’ünde (%67,2) hafif hasar (grade 0-1-2) ve 11’inde (%8,8) ciddi hasar (grade 3-4) vardı. Asidik madde alanlarda hasar oranı ve yaygın tutulum (özofagus ve mide) alkali alanlara göre daha fazla izlendi. Sonuç: Hastaların yaklaşık 2/3’üne endoskopi literatürde önerildiği şekilde, ilk 24-48 saat içinde yapılmıştı. Bilinenin aksine bizim çalışmamızda asidik maddeler hem daha fazla hasara hem de daha yaygın bir tutuluma neden olmuşlardır. Bu nedenle asidik madde alan hastalar da dikkatli izlenmeli ve gereken tedaviler vakit kaybedilmeden yapılmalıdır.

Keywords

Koroziv alımı, koroziv hasarlanma, özofagus, mide

Retrospective evaluation of corrosive injuries

Abstract

Background and Aims: Even though corrosive ingestion was primarily detected accidentally in children, it is still found in the adult age group. The injury that can occur is directly related to the type, quantity, and duration of contact of the ingested material with the mucosa. Early detection of injury is the most important step in the treatment, and endoscopic imaging constitutes the most important method in this regard. In this study, a retrospective evaluation of corrosive injuries was conducted among the adult population. Materials and Methods: This study included a total of 125 patients aged more than 18 years who were admitted to our hospital with corrosive ingestion between January 01, 2008 and July 01, 2017. On the basis of the endoscopic findings, patients with grade 0-1-2 injuries were considered as those with mild injury and patients with grade 3-4 injuries were considered as those with severe injury. Corrosive substances were categorized as acidic, alkali, and others according to their properties. Results: The mean age of the 125 patients (62 females; 63 males) was 39.3±15.1 years. Endoscopy was performed in the first 24–48 h in 90 patients (72%). A total of 95 patients (76%) accidentally ingested the substance, whereas 30 patients (24%) intentionally did so. Involvement was only esophageal in 14 (77.4%) patients, only gastric in 43 (45.3%) patients, and both gastric and esophageal in 38 (40%) patients. Mild damage (grade 0-1-2) was found in 84 (67.2%) patients, and severe damage (grade 3-4) was detected in 11 (8.8%) patients. The rate of damage and widespread involvement (both esophageal and gastric in acidic substance ingestions were higher than that in alkaline substance ingestions. Conclusion: Approximately two-thirds of the patients underwent endoscopy in the first 24–48 h in accordance with the literature. In contrast with the literature, our study findings state that acidic substances caused both more damage and more extensive involvement. Therefore, patients who have ingested acidic substances should be carefully monitored and treated.

Keywords

Corrosive ingestion, corrosive injury, esophagus, stomach

References

• 1. Koçak E. Özofagus’un acil problemleri. Endoskopi 2010;18(2):46-51. 2. Gumaste VV, Dave PB. Ingestion of corrosive substances by adults. Am J Gastroenterol. 1992 Jan;87(1):1-5. 3. Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013;19:3918-3930. 4. Karaoğlu AÖ, Özütemiz Ö, İlter T, Batur Y, Yönetçi N, Tekeşin O. Caustic ingestion injuries: evaluation of 108 cases. Turk J Gastroenterol 1998; 9: 55-60. 5. Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiberoptic endoscopy in the management of corrosive ingestion and modifiedendoscopic classification of burns. Gastrointest Endosc 1991;37:165-169. 6. Uyar S, Kök M. Neutrophil to lymphocyte ratio as a predictor of endoscopic damage in caustic injuries. J Clin Toxicol 2017;7(3). Doi: 10.4172/2161-0495.1000349 7. 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(3):702-707. 8. Mamede RC, de Mello Filho FV. Ingestion of caustic substances and its complications. Sao Paulo Med J. 2001 Jan 4;119(1):10-5. 9. Havanond C. Is there a difference between the management of grade 2b and 3 corrosive gastric injuries? J Med Assoc Thai. 2002 Mar;85(3):340-4. 10. Cabral C, Chirica M, de Chaisemartin C, Gornet JM, Munoz-Bongrand N, Halimi B, ve ark. Caustic injuries of the upper digestive tract: a population observational study. Surg Endosc. 2012 Jan;26(1):214-21. 11. Poley JW, Steyerberg EW, Kuipers EJ, Dees J, Hartmans R, Tilanus HW, ve ark. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc. 2004 Sep;60(3):372-7. 12. Cheng HT, Cheng CL, Lin CH, Tang JH, Chu YY, Liu NJ, ve ark. Caustic ingestion in adults: the role of endoscopic classification in predicting outcome. BMC Gastroenterol. 2008 Jul 25;8:31. 13. Goldman LP, Weigert JM. Corrosive substance ingestion: a review. Am J Gastroenterol. 1984;79(2):85.