Corrosive injury

Skilled early endoscopy is useful in corrosive injury

Corrosives such as sodium hydroxide (lye) or sulphuric acid may be taken in attempted suicide. Bleach may be drunk by young children. All can cause severe damage to the pharynx, larynx, oesophagus and stomach. The oesophagus is usually worst affected by sodium hydroxide. The key to management is early endoscopy by an experienced endoscopist to inspect the whole of the oesophagus and stomach unless there is a severe necrotising lesion. Air insufflation should be kept to a minimum. Minor injuries resolve rapidly with no late sequelae. Severe mucosal injury (Fig. 50.21) should be treated with steroids for 3 weeks and a programme of regular dilatations started thereafter. If full-thickness necrosis is suspected resection should be done at an early stage.

Cases that present late may have extensive stricturing of the oesophagus that is difficult to dilate (Figs 50.22 and 50.23). Oesophageal resection may be required. Some advocate surgical bypass rather than resection as there may be a very marked fibrous peri-oesophagitis in late cases.