[A diagnostic and therapeutic algorithm in cases of acute corrosive burns of esophagus and stomach in childhood - 36 year clinical experience].

INTRODUCTION

The chemical burn of the esophagus and stomach, caused by concentrated acids or alkalis, is related to the development of a multitude of serious surgical complications and represents an actual social and medical problem.

AIM: Presentation of an algorithm of therapeutic measures in cases of corrosive burns of esophagus and stomach in children with the acute and chronic phase of the disease, developed on the grounds of our long-term clinical experience.

CLINICAL MATERIAL: The studies and practical conclusions were based on out 36-year experience (from the year 1976 to 2012) in the treatment of 816 children with corrosive disease, treated at the Department of Pediatric Thoracic Surgery and the Department of Pediatric Toxicology of the General Hospital "N. I. Pirogov" -Sofia.

RESULTS

581 children (71.2%) in the acute phase of the corrosive intoxication were admitted for treatment. The rest 235 children (28.8%) were admitted for treatment in the late phase with formed fibrotic stricture of esophagus or stenosis of pylorus. Early diagnostic endoscopy was performed in 244 children (41.9 %). 83 children (34 %) had corrosive burn of 0-1 degree; 30 (13.3 %) -burn of 2-a grade; 123 (50 %) - burns of II-B and III grade; and 9 (3.7 %) - burn of 4 grade. Conservative treatment with bougienage was performed in 345 children (89.4 %). Esophageal replacement was performed in 81 children - colon was used in 57 of them, and whole stomach - in 24. Early surgical complications in the acute phase of the corrosive disease were observed in 99 children (25.1 %). Lethal outcome occurred in 9 children - colon was used in 57 of them, and whole stomach - in 24. Early surgical complications in the acute phase of the corrosive disease were observed in 99 children (25.1 %). Lethal outcome occurred in 9 children (2.4 %) died in the course of the conservative and surgical treatment.

CONCLUSION

The corrosive disease is a complex pathological process, which involves not only the upper digestive tract, but also the entire organism. The main burden during the course of disease falls over the surgical complications in the acute phase. The treatment of the late sequelae of the corrosive disease requires complex conservative and surgical approach, which on its turn requires availability of a sophisticated multidisciplinary medical team.