Cases reported "Burns, Chemical"

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11/76. Clinitest burns of the esophagus.

    Five children developed esophageal stricture from the ingestion of a Clinitest tablet. The sodium hydroxide contained in these tablets induced a short, dense stricture that was resistant to dilation and necessitated resection. In all patients primary esophageal resection with end-to-end anastomosis was technically possible. Four of the patients needed two or more dilations postoperatively and 1 still requires dilation. Prevention of accidental ingestion by use of a childproof container and parental education about the caustic nature of Clinitest are both essential to eliminate this child health hazard.
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12/76. Corrosive oesophageal injury following vinegar ingestion.

    A 39-year-old woman drank one tablespoon of white vinegar in order to 'soften' crab shell stuck in her throat. endoscopy revealed inflammation of the oropharynx and second-degree caustic injury of the oesophagus extending to the cardia. She had an uneventful recovery. This case report confirmed that vinegar could cause ulcerative injury to the oropharynx and oesophagus. The folklore application of vinegar 'dislodging' a foreign body in the throat should be strongly discouraged.
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13/76. A new technique for esophagoplasty in relatively long esophageal strictures.

    A 3-year-old girl with severe dysphagia secondary to caustic stricture of the cervical esophagus (about 4 cm in length) underwent esophagoplasty by a new technique following failed attempts at esophagoscopy and dilatation. This procedure results in a neoesophagus in the region with a lumen approximately twice its previous diameter, which will further increase in size gradually after a number of dilatations. The postoperative course was uneventful. She had almost no dysphagia following four successive dilatations 1, 2, 3 and 5 months after surgery. barium swallow revealed an acceptable lumen. She was asymptomatic 2 years after surgery.
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14/76. A new method of subcutaneous placement of free jejunal flaps to reconstruct a diversionary conduit for swallowing in complicated pharyngoesophageal injury.

    Choking is a serious problem in pharyngoesophageal reconstruction, which may occur following tumor ablation of the pharynx or following corrosive injury involving the epiglottis and other parts of the upper airway. To prevent choking and the risk of severe pulmonary complications, patients have to give up oral intake and assume feeding via jejunostomy for the rest of their lives. After reconstruction of the esophagus, eight patients experienced frequent choking and aspiration. With a free jejunal flap, the inlet for food could be separated from the route of the upper airway by a diversion technique. The jejunum segment was transferred microsurgically to reconstruct the cervical esophagus, with its inlet at the buccogingival sulcus. There were no surgical complications related to either the free jejunal flap transfer or the donor site. Postoperatively, patients require re-education of their pattern of swallowing, but after the rehabilitation period all patients reported a satisfactory oral intake through the reconstructed esophagus to the abdomen without choking. There were no episodes of aspiration following reconstruction. With this new method to create a separate food pathway, patients can resume oral intake safely without choking and without permanent jejunostomy. This technique offers a useful solution for patients who suffer from recurrent choking and aspiration following injury or ablation of the pharynx.
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15/76. Use of a cutting balloon in the dilatation of caustic oesophageal stricture.

    A 14-year-old boy was admitted with absolute dysphagia 1 year after he had swallowed drain cleaner. Contrast swallow showed a tight stricture of the whole of the oesophagus below the level of T2. Attempted dilatation to 8 mm using conventional balloons was performed on two occasions, but there was residual waisting. An 8-mm cutting balloon (Peripheral Cutting Balloon, boston Scientific) was used to abolish this waisting, and full dilatation to 10 mm was performed in the same procedure. Subsequent serial dilatation to 20 mm has been successful and the patient is now able to swallow normal food with cessation of gastrostomy feeding. This is believed to be the first report of the use of a cutting balloon to treat an oesophageal stricture.
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16/76. Severe esophageal damage due to button battery ingestion: can it be prevented?

    Batteries represent less than 2% of foreign bodies ingested by children, but in the last 2 decades, the frequency has continuously increased. Most ingestions have an uneventful course, but those that lodge in the esophagus can lead to serious complications and even death. medline was used to search the English medical literature, combining "button battery" and "esophageal burn" as keywords. Cases were studied for type, size, and source of the batteries; duration and location of the battery impaction in the esophagus; symptoms; damage caused by the battery; and outcome. Nineteen cases of esophageal damage have been reported since 1979.Batteries less than 15 mm in diameter almost never lodged in the esophagus. Only 3% of button batteries were larger than 20 mm but were responsible for the severe esophageal injuries in this series. These data suggest that manufacturers should replace large batteries with smaller ones and thus eliminate most of the complications. When the battery remains in the esophagus, endoscopic examination and removal done urgently will allow assessment of the esophageal damage, and treatment can be tailored accordingly. There is a need for more public education about the dangers of battery ingestion; this information should be included as part of the routine guidelines for childproofing the home.
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17/76. Pediatric caustic ingestion and parental cocaine abuse.

    OBJECTIVE: To report two cases in which toddlers drank a caustic liquid which their parents had been using to prepare free-base and crack cocaine. DESIGN: Case series. RESULTS: Two toddlers presented with first- and second-degree burns of the oral cavity, pharynx and esophagus from caustic ingestion. The first had drunk ammonia from an unmarked clear plastic container the morning after "a party at a friend's house". The second had drunk potassium hydroxide from a clear plastic container which was labelled "pH UP" and had a small "Danger" sign. Both children were treated with intravenous hydration, steroids, antibiotics and analgesics. Fortunately, neither child suffered long-term physical sequelae. When questioned, the parents of both children admitted to using these alkalis to prepare free-base and crack cocaine. Appropriate steps were taken by social services to protect these children from further neglect. DISCUSSION: Despite federal legislation and public education, pediatric caustic ingestion remains a significant problem. These cases suggest that, in certain cases of pediatric caustic ingestion, caregivers should be questioned regarding possible drug abuse. Larger warning labels and further public education might help prevent many cases of pediatric caustic ingestion.
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18/76. Button battery ingestion.

    Button batteries represent a special category of pediatric ingested foreign body because of the possibility of serious complications particularly if impacted in the esophagus. We report a case of a 3-year-old girl with severe mid esophageal burns due to a lodged battery. More awareness is required amongst physicians to avert such dangers and ensure prompt removal.
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ranking = 0.25
keywords = esophagus
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19/76. Esophageal replacement by Lexer's esophagoplasty: adenocarcinoma as late complication.

    The most successful method for esophageal reconstruction in the early 20th century was the jejunodermatoesophagoplasty after Lexer, involving the presternal formation of a skin tube for passage reconstruction. A 59-year-old patient presented to our hospital with adenocarcinoma at the dermatojejunostomy 47 years after undergoing a Lexer procedure. The neoesophagus was removed, and the passage was reconstructed by a retrosternal colonic interposition. Although squamous cell carcinoma is known as a late complication of dermatoesophagoplasties, this is a reported case of adenocarcinoma formation.
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20/76. Fibreoptic intubation in cicatricial membranes of the pharynx.

    Two patients presented with almost total obliteration of the pharynx. In one, a membrane developed after corrosive poisoning; in the other, the oropharynx was filled with a dense cicatrix in the sclerosing phase of rhinoscleroma. In both patients, a single opening in the membrane provided access to both the larynx and oesophagus. Fibreoptic intubation allowed both a thorough assessment of the pathology and subsequently the passage of a cuffed tracheal tube to secure the airway. To overcome the problem of respiratory obstruction while the fibrescope passed through the opening in the membrane, either rapid intubation, or a technique using pre-oxygenation and voluntary hyperventilation followed by breath-holding during bronchoscopy, was used. The thin calibre and manoeuvrability of the flexible fibreoptic bronchoscope makes fibreoptic intubation an excellent technique of airway management in cicatricial membranes of the pharynx.
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