Chemical burns of the esophagus in children
Introduction
Introduction to children's esophageal chemical burns Esophageal chemical corrosion injuries are more common in children under 5 years of age, generally caused by the misuse of strong acids and alkalis. In recent years, esophageal chemical corrosion injuries have decreased. The incidence is higher in the north than in the south, in North China, and in rural areas of Central China. basic knowledge The proportion of illness: 0.02% (the probability of illness in infants and young children is 0.02%) Susceptible people: more common in children under 5 years old Mode of infection: non-infectious Complications: perforation of the esophagus Pediatric gastrointestinal bleeding Peritonitis Laryngeal edema Aspiration pneumonia Lung abscess Bronchiectasis
Cause
Pediatric esophageal chemical burns
(1) Causes of the disease
Children and preschool children often cause chemical burns of esophagus due to misuse of strong acid, strong alkali or other corrosive drugs. In addition, they can also burn the esophagus by mistakenly drinking boiled water. The pathological changes caused by strong acid and alkali burns are different. The acidic substance causes coagulative necrosis of the contact surface, and the mucous membrane attached to the esophageal squamous epithelium can resist acid and prevent the acid from penetrating into the deep tissue to allow the acidic substance to reach the stomach. The alkaline substance can dissolve protein, collagen and fat, causing liquefaction necrosis. Infiltration into deep tissues causes extensive damage, early edema and tissue necrosis of esophageal chemical burns, ulceration after detachment, proliferation of surrounding tissues, granulation growth, collagen accumulation, adhesions and scar formation, and deep ulcers can cause perforation.
(two) pathogenesis
The severity of chemical burns of esophagus is closely related to the nature, concentration, quantity and length of contact with esophagus. The strong alkali substance has strong water absorption, and it has the function of fat saponification and dissolved protein. Ions have the characteristics of continuing to erode deep into the tissue, which can cause severe burning of the esophagus, which can cause scarring of the esophageal scar. In severe cases, the esophageal scar can be blocked or the esophagus can be perforated. The strong acid can dehydrate the tissue, coagulate the protein, and cause local scarring. The damage is not easy to invade deep, the scar is formed shallow, and the stenosis is lighter. However, if the amount of misuse is large, acidosis may occur, and the entry of strong acid into the stomach may cause damage to the stomach wall, even the perforation of the stomach, and the erosion of corrosion. The part is related to the swallowing physiology. The burning pain caused by the accidental application of the corrosive agent can cause the circumflex pharyngeal muscle to produce strong contraction, and then the erosive agent can be swallowed rapidly, and enters the middle and lower segments through the esophageal inlet and the upper segment to enter the stomach. Therefore, the upper segment is damaged. Lighter, only 10%, the middle esophageal muscle is smooth muscle, weak contraction, slow etchant, contact Relatively long, so the damage is heavier, the esophageal scar stenosis occurred in the middle segment accounted for about 70%, the lower end of the esophagus less damage, and the amount of accidental corrosive agents is generally not too much, multiple esophageal stricture accounted for 20% to 25% The incidence of total esophageal stricture was only 5%.
Prevention
Pediatric esophageal chemical burn prevention
Prognosis:
Patients with mild corrosive esophageal injury may have no complications. Patients with severe burns are prone to acute complications such as esophageal perforation, hemorrhage, tracheoesophageal fistula, high mortality, stenosis of more than 70% of IIb or III esophageal burns, all esophagus The incidence of esophageal stenosis in corrosive lesions is 10% to 30%, and the risk of esophageal squamous cell carcinoma is significantly increased in patients with esophageal stenosis after esophageal corrosive injury. The incidence is more than 1000 times that of the general population, so long-term esophageal stenosis Patients with symptoms such as stenosis should be aware of the possibility of esophageal cancer.
prevention:
1. Strict management to prevent esophageal damage caused by eating strong acid and alkali.
2. Strengthen education to prevent adolescents and adults from having suicidal intentions and ingesting strong acid and alkali.
Complication
Pediatric esophageal chemical burn complications Complications Esophageal perforation Pediatric gastrointestinal bleeding Peritonitis Laryngeal edema Aspiration pneumonia Lung abscess Bronchiectasis
Complications after swallowing corrosive agents can be divided into local and systemic
1. Systemic complications are more toxic, there is systemic poisoning, and severe cases die within a few hours or within 1-2 days.
2. Local complications
(1) Bleeding: A small amount of vomiting may occur within a few days after taking the poison, but a large amount of bleeding is caused by the shedding of necrotic tissue, which often occurs within 1 to 2 weeks. Generally, a large amount of bleeding suddenly occurs in about 10 days. Because of the inability to stop and die, it is better for patients with severe symptoms to disappear after 1 week. It is best to stay in bed and go to the fluid diet until 2 weeks, so that there is not much bleeding.
(2) esophageal perforation and mediastinal inflammation: only in patients with swallowed venom is too thick and large, generally alkaline corrosion is more likely to occur in the esophageal perforation, more at the lower end of the esophagus rupture to the left chest cavity, sometimes through to The trachea forms a tracheal esophageal fistula, and there have been reports of accidental rupture to the aortic arch in the literature.
(3) Gastric burns, gastric perforation and peritonitis: more complicated with acidic corrosive agents, showing acute abdominal symptoms and critical illness.
(4) laryngeal edema, aspiration pneumonia, lung abscess and bronchiectasis: can be complicated by acute corrosive esophagitis and scar stenosis, especially in children.
(5) esophageal scar stenosis: often an inevitable complication, only early prevention can prevent it, stomach scar stenosis is often complicated in patients swallowing acidic corrosive agents.
Symptom
Pediatric esophageal chemical burn symptoms common symptoms high heat dysphagia chest pain shock dyspnea hemoptysis sputum dehydration rogue refusal
1. Indexing of esophageal chemical burns
(1) Once burned: only injured mucous membrane, submucosa, local congestion, edema, exudation, mucosal epithelial shedding, generally no scar stenosis, common in burns caused by misuse of iodine, come to Su, etc., mucosal repair Fast, a few days can be more.
(2) Second degree burn: In addition to the damaged mucous membrane, the submucosa, involving the muscular layer, early (1 to 4 days) severe congestion of the esophageal mucosa, hemorrhage, followed by surface necrosis, local membranous membranous exudate, pseudomembrane After exfoliation, deep ulcers and granulation can be formed. Inflammation, edema and necrotic tissue begin to regress in about 2 weeks. At the third week, the wound begins to repair, connective tissue shrinks, submucosa and myometrial necrotic tissue are replaced by fibrous tissue, and the scar is 4 weeks. Contraction, gradual formation of stenosis, esophageal elasticity also disappeared, peristaltic function decreased, children gradually appear obvious difficulty in swallowing.
(3) Third degree burn: burns deep into the muscular layer and the whole layer, and even erodes the tissue around the esophagus. In severe cases, esophageal perforation and mediastinal inflammation may occur. In the acute phase, there may be symptoms of poisoning and shock, electrolyte imbalance.
2. Clinical manifestations of patients with esophageal chemical corrosion injury
(1) acute phase: immediately after the injury, the lips, tongue, mouth, throat and esophagus burn, the children showed crying, running, dysphagia, refusal to eat, mucosal edema occurred after 1~2h, peaked at 6h, edema at this time Severe, if the edema affects the throat, hoarseness and inspiratory dyspnea may occur. In severe cases, suffocation may occur due to larynx obstruction.
1 Once burned: In addition to the above symptoms, the symptoms of poisoning and dysphagia are obvious, and children have different degrees of dehydration and electrolyte imbalance.
2 second degree burns: can show severe symptoms of poisoning, such as high fever, shock, etc.; if esophageal perforation occurs, sick children often complain of chest pain, belching, injury and large blood vessels in the chest, then sudden hemoptysis, hematemesis, and soon die.
(2) Subacute phase: also known as the period of inflammation dissipation, about 2 to 3 weeks after burns, acute inflammation is relieved in this period, esophageal edema and congestion are subsided, dysphagia is improved, and the general condition of the sick child is also improved.
(3) scar stenosis period: generally 3 to 5 weeks after burn, scar formation and gradual stenosis, so dysphagia again, and the symptoms are more serious, even esophageal atresia, sick children vomit or drip after eating, Common salivation, dehydration, acidosis and malnutrition, moderate to severe burns can immediately appear toxic shock, lips, oral mucosa, tongue and pharynx ulcers and tunica, swallowing pain and difficulty, runny, vomiting, can not eat Water, strong alkali injury and glottis, airway, breathing difficulties and cough, dehydration, acidosis and pulmonary infection, wound repair after 1 week, diet gradually recovered, a few weeks later due to esophageal scar stenosis Difficulty in swallowing, even unable to eat, but also cough due to concurrent reflux inhalation, bronchitis and pneumonia, according to medical history and physical examination can make a diagnosis, according to the obvious history of corrosive accidents, typical clinical symptoms, especially burns The posterior lip, the burnt performance of the pharyngeal cavity, and the difficulty of swallowing can often be diagnosed. The early meaning of X-ray examination is not significant. After 3 weeks, the esophageal barium meal examination can help diagnosis. The esophageal stricture is formed, and the location and severity of the esophageal burn can be observed. Although the esophagoscopy can directly look at the burned condition, there is a risk of causing perforation of the esophagus in the early stage, which is not suitable for implementation. The end of the stenosis can be observed in the late examination. General esophagoscopy is difficult to pass through the narrow segment of the entrance, so esophagoscopy should not be used for multi-segment or total esophageal stricture.
Examine
Examination of children's esophageal chemical burns
Laboratory examination: increased white blood cell count and decreased hemoglobin when combined with esophageal perforation and respiratory infection.
Other auxiliary inspections:
1. X-ray examination: X-ray examination should be performed after the acute inflammation subsides, the patient can swallow the food for esophagography, if there is suspected esophageal fistula or perforation, the contrast agent can flow into the respiratory tract, preferably using lipiodol. Different stages of lesion development and degree of injury are different, lighter: early is the secondary esophageal sputum, mucosal texture is still normal, can also be slightly thickened, distorted, late scar, stenosis is not obvious, moderate: esophageal involvement length increased Secondary sputum is prominent, and the mucosal texture is irregularly serrated or beaded. In severe cases, the lumen is obviously reduced, and even the tail is shaped.
2. Esophagoscopy: Except for shock or perforation, it should be implemented as soon as possible to determine the extent of the lesion to prevent obstruction due to stenosis. Regular endoscopic reexamination is required in addition to the dilated esophagus, early detection of esophageal cancer, due to cancer The incidence is higher than the normal esophagus, especially the esophageal stricture caused by strong alkali.
Diagnosis
Diagnosis and diagnosis of children's esophageal chemical burns
Corrosive esophagitis is generally not difficult to diagnose according to its medical history, symptoms and signs, and often coexist with corrosive gastritis, but in the clinical should pay attention to whether there are other lesions with esophagus, especially for middle-aged and elderly men, The identification of esophageal cancer, esophageal cancer with dysphagia, weight loss, etc. as the main performance, the condition is progressively aggravated, X-ray and gastroscopy combined with biopsy can confirm the diagnosis.
