Overview Of Corrosive Ingestion – Acid & Alkalis, and Management Approach

Corrosive ingestion refers to the consumption of substances that can cause damage to the mucous membranes and tissues of the gastrointestinal tract.

Types of Corrosives

1. Acids: Examples include hydrochloric acid, sulfuric acid, and nitric acid.

2. Alkalis: Examples include sodium hydroxide, potassium hydroxide, and ammonia.

Epidemiology

1. Accidental ingestion: More common in children.

2. Intentional ingestion: More common in adults, often as a means of self-harm.

Pathophysiology and Zargar Grading

1. Tissue damage: Corrosives can cause liquefaction necrosis (alkalis) or coagulative necrosis (acids)

2. Zargar grading: A classification system used to grade the severity of mucosal injuries:

Grade 0: Normal mucosa
Grade 1: Edema and hyperemia
Grade 2A: Friability, hemorrhages, erosions, blisters, and exudates
Grade 2B: Grade 2A findings with deep or circumferential ulcers
Grade 3A: Small scattered areas of necrosis
Grade 3B: Extensive necrosis

Symptoms and Signs

1. Oral and pharyngeal pain: Pain in the mouth, throat, and chest.

2. Dysphagia: Difficulty swallowing.

3. Vomiting: May be bloody.

4. Abdominal pain: Severe abdominal pain

Investigations

1. Oesophagogastroduodenoscopy (OGD): Crucial for assessing the extent of injury.

2. Contrast studies: May be used to evaluate for complications like perforation or stricture.

Role and Timing of OGD

1. Timing: OGD is typically performed within 12-48 hours after ingestion.

2. Role: OGD helps determine the extent and severity of the corrosive injury.

Role and Timing of Contrast Studies

1. Timing: Contrast studies may be performed if there's suspicion of perforation or if OGD is not feasible.

2. Role: Contrast studies can help identify complications like perforation or stricture.

Complications

1. Stricture formation: Narrowing of the esophagus or other parts of the gastrointestinal tract.

2. Perforation: Hole in the wall of the esophagus or stomach.

2. Infection: Bacterial or fungal infections can occur.

Timing of Oesophageal Dilation for Stricture

1. Early dilation: May be considered in some cases, but often delayed until the acute injury has healed.

2. Repeated dilation: May be necessary to maintain patency of the esophagus.

Management Options

Immediate care:

Supportive care, including management of pain, hydration, and nutrition.
Endoscopic dilation:

May be necessary for strictures.
Surgery:

May be required for perforation, severe injury, or complications like stricture.
Long-term follow-up:

Regular follow-up is necessary to monitor for complications and manage any long-term effects.

The management of corrosive ingestion requires a multidisciplinary approach, involving emergency medicine, gastroenterology, and surgery.

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