Abstract
Amaç: Çocuklarda korozif madde içimine bağlı özofagus yanıkları sık görülmektedir. Çocuk cerrahisi pratiğinde sık karşılaşılan, kaza ile korozif madde alımı yaşamı tehdit eden sorunlara yol açabilmektedir. Kliniğimize korozif madde içimi nedeni ile başvurarak özofagoskopi yapılan olguların tedavi sonuçları irdelenerek geriye dönük olarak değerlendirildi. Korozif maddelerin kazayla içilmesi önemli bir sağlık sorunudur. Bu çalışmada korozif made içmiş olan 319 çocuğun retrospektif olarak incelenmesi amaçlandı.Metod: Korozif madde içimi sonrası ilk 48 saat içerisinde özofagoskopi yapılan 319 olgu değerlendirildi. 118’i kız (%37), 201’i (%63) erkek olup yaşları 1ay ile 13 yaş arasında değişiyordu. Olgularımıza ilk endoskopik değerlendirme sonucuna göre bir tedavi protokolü uygulandı. Darlık gelişerek altı aydan uzun süre ile dilatasyon işlemi gerektiren olgularda ayrıca gastroözofageal reflü (GER) araştırması yapıldı.Bulgular: Toplam 148 olguda (%46) değişik derecelerde özofagus yanığı belirlenirken bu olguların 55’inde (%37) gelişen özofagus darlığına dilatasyonlar uygulandı. Endoskopik olarak yanık derecesi Grade 2b ve 3a olan olgularımızın tümü 6 aydan uzun süren dilatasyon programına gereksinim duydular. Bu olgularda 24 saat pHmetre monitorizasyon değerlendirmesi ile GER araştırıldı. Bu olguların %41’inde patolojik düzeyde GER saptanırken, tamamında özofagusta asit temizlenme zamanının uzamış olduğu görüldü.Sonuç: Korozif madde içen çocukların %17’inde özofagus darlığı gelişmektedir. Ciddi darlık ve dilatasyona daha geç yanıt veren olgularda ek olarak GER saptanması daha sıktır. Korozif özofagus yanıklarına bağlı olarak özofagus motilite bozuklukları ve GER sıklıkla görülen durumlardır ve tedavi stratejisini belirlerken mutlaka göz önüne alınmalıdır.
References
- de Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: a 30-year review. Int J Pediatr Otorhino- laryngol. 2001; 57:203-211.
- 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.
- Doğan Y, Erkan T, Cokuğraş FC, Kutlu T. Caustic gastroesopha- geal lesions in Childhood: an analyses of 473 cases. Clin Pediatr (Phila). 2006; 45:435-438.
- Tiryaki T ,Livanelioğlu Z, Atayurt H. Early bougienage for relief of stricture formation following caustic esophageal burns. Pedi- atr Surg Int. 2005 ;21: 78-80.
- Hamza AF, Abdelhay S, Sherif H, Hasan T, Soliman H, Kabesh A, Bassiouny I, Bahnassy AF. Caustic esophageal strictures in child- ren: 30 years’ experience. J Pediatr Surg. 2003; 38:828-833.
- Wijburg FA, Heymens HS, Urbanus NA. Caustic esophageal lesions in children:prevention of stricture formation. J Pediatr Surg.1989; 24:171-173.
- Atabek C, Surer I, Demirbag S, Calıskan B, Ozturk H, Cetinkur- sun S. Increasing tendency in caustic esophageal burns and long term polytetrafluorethylene stenting in severe cases: 10 years ex- perince. J Pediatr Surg. 2007;42:636-640.
- Huang YC, Ni YH, Lai HS, Chang MH. Corrosive esophagitis in children. Pediatr Surg Int. 2004 ;20: 207-210.
- Capella M, Goldberg P, Quaresma E, Araujo E, Pereime M. Per- sistance of corrosive esophageal stricture due to gastroesophageal reflux in children. Pediatr Surg Int. 1992; 7:180-182.
- 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.
- Genç A, Mutaf O. Esophageal motility changes in acute and late periods of caustic esophageal burns and their relation to progno- sis in children. J Pediatr Surg.2002; 37:1526-1528.
- Broto J, Asensio M, Jorro CS, Marhuenda C, Vernet JM, Acosta D, Ochoa JB.Conservative treatment of caustic esophageal inju- ries in children: 20 years of experience. Pediatr Surg Int.1999;15: 325.
- Hillemeier AC, Grill BB, McCallum R, Grybuski J. Esophageal and gastric motor abnormalities in gastroesophageal reflux du- ring infancy. Gastroenterology. 1983;84: 741-746.
- Maddern GJ, Jamieson GG. Oesophageal emptying in patients with gastro-oesophageal reflux. Br J Surg. 1986; 73: 615-617.
Abstract
Aim: Esophageal burns as a result of accidental swallowing of caustic material are seen frequently in children. Accidental ingestion of corrosive substances remains a major health hazard in children. The aim of this study was to evaluate the management of our 319 padiatric cases of corrosive substance ingestion retrospectively.Material and methods: We retrospectively analyzed the management of 319 padiatric cases of corrosive substance ingestion in whom initial management consisted of prompt endoscopy. There were 201 male and 118 female patients, age ranges between 1 month to 13 years. Treatment protocols were chosen according to the initial endoscopic evaluation. Gastroesophageal reflux (GER) was investigated in patients who needed esophageal dilatation programme for more than 6 months.Results: 148 patients (%46) were found to have esophageal burns and 55 (37%) of them underwent treatment for stricture formation. Patients with grade 2b and 3a injuries in endoscopic evaluation needed prolonged dilatations. Severe GER and abnormal pH monitorization results were noted in 41% of these patients. Delayed acid clearence was noted in all patients who needed prolonged dilatations..Conclusion: Esophageal stricture was noted in 17% of the patients after corrosive substance ingestion. Gastroesophageal reflux was frequently encountered after the development of severe stricture and prolonged esophageal dilatations. These results indicated that disturbances of motility and GER are frequent sequelae of caustic burns of the esophagus. Treatment modality should include the treatment of the gastroesophageal reflux, and esophageal motility disorders
References
- de Jong AL, Macdonald R, Ein S, Forte V, Turner A. Corrosive esophagitis in children: a 30-year review. Int J Pediatr Otorhino- laryngol. 2001; 57:203-211.
- 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.
- Doğan Y, Erkan T, Cokuğraş FC, Kutlu T. Caustic gastroesopha- geal lesions in Childhood: an analyses of 473 cases. Clin Pediatr (Phila). 2006; 45:435-438.
- Tiryaki T ,Livanelioğlu Z, Atayurt H. Early bougienage for relief of stricture formation following caustic esophageal burns. Pedi- atr Surg Int. 2005 ;21: 78-80.
- Hamza AF, Abdelhay S, Sherif H, Hasan T, Soliman H, Kabesh A, Bassiouny I, Bahnassy AF. Caustic esophageal strictures in child- ren: 30 years’ experience. J Pediatr Surg. 2003; 38:828-833.
- Wijburg FA, Heymens HS, Urbanus NA. Caustic esophageal lesions in children:prevention of stricture formation. J Pediatr Surg.1989; 24:171-173.
- Atabek C, Surer I, Demirbag S, Calıskan B, Ozturk H, Cetinkur- sun S. Increasing tendency in caustic esophageal burns and long term polytetrafluorethylene stenting in severe cases: 10 years ex- perince. J Pediatr Surg. 2007;42:636-640.
- Huang YC, Ni YH, Lai HS, Chang MH. Corrosive esophagitis in children. Pediatr Surg Int. 2004 ;20: 207-210.
- Capella M, Goldberg P, Quaresma E, Araujo E, Pereime M. Per- sistance of corrosive esophageal stricture due to gastroesophageal reflux in children. Pediatr Surg Int. 1992; 7:180-182.
- 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.
- Genç A, Mutaf O. Esophageal motility changes in acute and late periods of caustic esophageal burns and their relation to progno- sis in children. J Pediatr Surg.2002; 37:1526-1528.
- Broto J, Asensio M, Jorro CS, Marhuenda C, Vernet JM, Acosta D, Ochoa JB.Conservative treatment of caustic esophageal inju- ries in children: 20 years of experience. Pediatr Surg Int.1999;15: 325.
- Hillemeier AC, Grill BB, McCallum R, Grybuski J. Esophageal and gastric motor abnormalities in gastroesophageal reflux du- ring infancy. Gastroenterology. 1983;84: 741-746.
- Maddern GJ, Jamieson GG. Oesophageal emptying in patients with gastro-oesophageal reflux. Br J Surg. 1986; 73: 615-617.
Details
| Other ID | JA37SG69HF |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 1, 2009 |
| Submission Date | August 1, 2009 |
| Published in Issue | Year 2009 Volume: 3 Issue: 2 |
The publication language of Turkish Journal of Pediatric Disease is English.
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