Pediatric emergency medicine trisk 4079 4079
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Symptomatic patients who have respiratory symptoms or who are unable to
achieve adequate oral intake should be admitted for observation and definitive
management. Often, a thin membranous web may be split by esophageal dilators,
cautery, or a hydraulic balloon placed endoscopically across the stenosis. If this
approach is unsuccessful because the lumen is too small to accommodate the
dilator or the tissue is unyielding, segmental esophageal resection may be
necessary via thoracotomy or thoracoscopy.
Caustic Ingestion
Caustic ingestion is the leading toxic exposure in children, and can cause
devastating injury to the esophagus and stomach with dire consequences. The
most frequent exposures in children are to mild alkali agents such as household
bleach and detergents, some of which can be relatively benign. Button battery
ingestions in children are increasingly common and can be extremely dangerous
(see Chapters 91 Gastrointestinal Emergencies and 118 ENT Emergencies for a
full discussion ). The age distribution of pediatric ingestions is bimodal, with
accidental ingestions common in children younger than 5 years and suicide
attempts more common in teenagers and young adults. The extent and severity of
injury depends on the type, concentration, and quantity of the ingested agent, as
well as the duration of exposure. Liquid agents typically cause more injury than
solids, with strong alkalis being associated with very severe damage. Following
the initial ingestion of an acid or alkali, a significant inflammatory response with
edema, hemorrhage, and thrombosis can occur within 24 hours. Local tissue
damage continues for some time after the initial exposure, causing necrosis,
edema, potential perforation, and eventual fibrosis and stricture.
