Caustic ingestion management

Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature. Introduction/Background Caustic ingestion may result in significant injury to the entire gastrointestinal tract, but most significantly the upper tract, including the oropharyngeal cavity, larynx, esophagus, and stomach. The majority (68 %) of cases worldwide involve children as a result of unintentional, accidental ingestion of caustic substances. The remainder of cases reported are adults with psychiatric disturbances, some after suicide attempts, or alcoholics [1, 2]. As expected, the resultant severity of injury in caustic ingestion is determined by the type of ingested substance the amount and the time of tissue exposure. Due to the substantial morbidity and mortality associated with these injuries, the medical community demanded legislative action. Through persistent efforts, the Federal Caustic Act of 1927 was enacted, requiring appropriate labeling of caustic substances, such as lye. Subsequently, the Poison Prevention Packaging Act of 1970 directed the US Consumer Product Safety Commission to require childproof containers and improved labeling of caustics and other potentially harmful household products. These legislative acts caused dramatic decline in the occurrence of this type of injury in developed countries. However, in developing countries the incidence is still much higher [3]. While the injury pattern frequently seen in children is usually relatively minor due to smaller amounts ingested, in adults much larger quantities of the caustic substance frequently result in severe injury [3–5]. Injury caused by alkali or acid results in a different injury pattern. For example, alkali causes almost no irritation to the oral cavity, which usually results in larger ingested volumes entering the GI tract. Furthermore, because Alkali materials are thicker, they lead to longer exposure durations in the esophagus, causing progressive injury via liquefactive necrosis. This process may take as long as two weeks to manifest itself, and is heralded by progressive thinning of the esophagus lining. The stomach and duodenum, on the other hand, are less prone to such injury, due to the neutralizing effect of gastric acids and avoidance of pyloric spasm. Accordingly, maintenance of gastric emptying results in limited exposure of the gastric mucosa to alkali. In contrast to alkali, acids induce a burning sensation with subsequent pain immediately after contact with oral mucosa; accordingly, the volumes traditionally ingested * Correspondence: Y_kluger@rambam.health. gov.il Rambam Health Care Center, POB 9602, Haifa 31096, Israel Full list of author information is available at the end of the article WORLD JOURNAL OF EMERGENCY SURGERY © 2015 Kluger et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Kluger et al. World Journal of Emergency Surgery (2015) 10:48 DOI 10.1186/s13017-015-0043-4