ORIGINAL ARTICLE Didem Baskın Æ Nafiye Urgancı Æ Latif Abbasog˘lu Canan Alkım Æ Mehmet Yalc¸ın Æ C¸etinKaradag˘ Nihat Sever A standardised protocol for the acute management of corrosive ingestion in children Accepted: 24 August 2004 / Published online: 9 November 2004 Ó Springer-Verlag 2004 Abstract Oesophageal strictures developing after caustic ingestion in children are a serious problem, and several protocols to prevent stricture formation have been proposed. A prospective clinical trial was conducted for preventing strictures in caustic oesophageal burns in a single clinic, and the results are presented. All children with caustic ingestion who had oesophagoscopy for diagnosing the severity of the burn were included in the study. Eighty-one children were included in the series, with ages ranging between 3 months and 12 years. The patients were given nothing by mouth until oesopha- goscopy. IV fluids, broad-spectrum antibiotics, raniti- dine, and a single-dose steroid were given. Oral burns were positive in 66 patients. Oesophagoscopy revealed a normal oesophagus in nine patients, grade 1 burn in 24, grade 2a in 21, grade 2b in 23, grade 3a in two, and grade 3b in one. Patients with grade 1 and 2a burns were discharged after oesophagoscopy. Patients with grade 2b and all grade 3 burns were given nothing by mouth for a week except water when swallowing their saliva, and were fed via total parenteral nutrition. After the 1st week, if there was no problem with swallowing, liquid foods were introduced. No intraluminal tubes were used. At the end of the 3rd week, a barium meal was administered and an upper gastrointestinal series taken. Dilatation was performed at 2-week intervals for strictures, which developed in one grade 2a patient, six grade 2b patients, and the grade 3b patient. Only one of these patients is currently on an oesophageal dilatation program. Limiting oral intake and avoiding foreign bodies in the oesophagus seem to provide a good success rate; however, further prospective studies are needed to decrease the incidence of corrosive oesophageal stric- tures. Keywords Oesophagus Æ Corrosive ingestion Æ Caustic burns Æ Stricture Introduction After authorities heeded advice to require standardisa- tion of the dilutions of corrosive agents, cases of cor- rosive oesophagitis decreased in Turkey during the 1980s. Subsequently, as new chemical agents for domestic cleaning were introduced through formal market channels, they also began to find their way onto the informal market, being sold in any kind of empty bottle or paper bag at a lower price. Alkali agents are mainly kept in used water bottles and have been mis- taken for water, and acid agents look like candy and have been swallowed. As a result, within the last decade the number of cases of corrosive oesophagitis has begun to increase once more. Frequently, no information is available about the concentration of the agents involved because of the absence of labelling on containers. The victims are usually the children of families of low edu- cational level and economic status. Oesophageal burns may result in stricture formation. There is no standard treatment of caustic ingestion during the acute phase; several treatment strategies are described in paediatric surgery books [2, 11]. In our prospective study of corrosive oesophageal burns, treatment was planned to decrease the effects of infec- tion on injured oesophageal wall tissue, thus decreasing the incidence of stricture formation. D. Baskın(&) Pehlivanyanı Sok. 7/4, 34934 Mecidiyeko¨y, _ Istanbul, Turkey E-mail: didibas@tnn.net D. Baskın Æ L. Abbasog˘lu Æ M. Yalc¸ ın Æ C¸.Karadag˘ Æ N. Sever Department of Pediatric Surgery, S¸is¸li Etfal Education and Research Hospital, _ Istanbul, Turkey N. Urgancı Department of Pediatric Gastroenterology, S¸is¸li Etfal Education and Research Hospital, _ Istanbul, Turkey C. Alkım Department of Adult Gastroenterology, S¸is¸li Etfal Education and Research Hospital, _ Istanbul, Turkey Pediatr Surg Int (2004) 20: 824–828 DOI 10.1007/s00383-004-1294-4