Author(s)
Isobel O'Riordan, MBBChBAO MCh
Reza Rahbar, MD
Jennifer Shehan, MD
Joseph Peterson, MD
Sarah Francisco, BS
Erika Mercier, MD
Karen Watters, MBBChBAO
Sukgi Choi, MD
Benjamin Zendejas Mummert, MD
Affiliation(s)
Boston Children's Hospital
Abstract:
Introduction:
Pediatric caustic ingestion is an uncommon but potentially devastating event. Due to the rarity of these injuries, many surgeons’ direct experience of these cases may be limited. The aim of this study was to evaluate patients with caustic ingestion injury referred to a pediatric tertiary referral center with regards to presentation, surgical intervention, and outcomes.
Method: s
Following institutional review board ethical approval, a retrospective review was performed of all cases of caustic ingestion presenting to a tertiary pediatric hospital over a 10-year period (2012- 2022). Data collected included demographic details, initial presentation, medical and surgical intervention with primary goal to evaluate the swallowing and airway status at presentation and post intervention.
Results:
Seventeen patients were included, with a mean age of 4 years (Range 1-13 years). In 7 patients (41%) airway evaluation demonstrated oropharyngeal or supraglottic scarring. Treatment of the scarring was undertaken with scar division in 4 patients, and 3 patients underwent pharyngoplasty with tubed ALT free flap reconstruction. Fifteen patients (88%) had esophageal strictures, 9 were treated with repeat dilatations, 5 patients underwent stricture resection with jejunal interposition graft. Seven patients required tracheostomy for airway management. Three were successfully decannulated. Eight patients (47%) achieved full oral diet post intervention, 7 (41%) were taking oral diet with G tube supplementation, and 2 patients (12%) were gastrostomy tube dependent with no oral diet. Vocal fold status was assessed in 10 patients, 3 patients had a left vocal fold paralysis, and one patient had a transient neuropraxia following stricture resection.
Conclusion:
Caustic ingestion in the pediatric population are potentially devastating events. A subset of patients has severe, difficult to repair, sequelae which affect the upper aerodigestive tract. Patients with severe upper aerodigestive injuries should be managed at an institution with multidisciplinary experts in airway, respiratory, digestive, and plastic reconstructive team