Caustic Ingestion

Liquid alkali solutions (e.g., Drano and Liquid-Plumr) are responsible for most of the serious caustic esophageal and gastric injuries, producing coagulation necrosis in both organs. Acid ingestion is more likely to cause isolated gastric injury.

A. Initial management

Initial management is directed at hemodynamic stabilization and evaluation of the airway and extent of injury.

Airway compromise can occur from burns of the epiglottis or larynx and may require tracheostomy.

Fluid resuscitation and broad-spectrum antibiotics should be instituted.

Vomiting should not be induced, but patients should be placed on nothing-by-mouth status and given an oral suction device.

Steroids are of no proven benefit.

B. Evaluation

Evaluation with water-soluble contrast esophagography and gentle esophagoscopy should be done early to assess the severity and extent of injury and to rule out esophageal perforation or gastric necrosis.

C. Management

Without perforation, management is supportive, with acute symptoms generally resolving over several days.

Perforation, unrelenting pain, or persistent acidosis mandate surgical intervention. A transabdominal approach is recommended to allow evaluation of the patient’s stomach and distal esophagus. If it is necrotic, the involved portion of the patient’s stomach and esophagus must be resected, and a cervical esophagostomy must be performed. A feeding jejunostomy is placed for nutrition, and reconstruction is performed 90 or more days later.

Late problems include the development of strictures and an increased risk of esophageal carcinoma (1,000 times that of the general population).