■儿童中的苛性碱摄入是一个公共卫生问题;主要是由于腐蚀性产品的包装和储存不当造成的家庭事故。这是一种医疗和外科紧急情况,其管理是多学科的。在10%的病例中,由于意外摄入腐蚀性物质而引起的病变会影响功能和生命预后。
■回顾,2020年1月至2022年12月(2年)的描述性研究,在尼亚美(尼日尔)综合参考医院急诊科进行。该研究包括因摄入腐蚀性产品而入院的15岁以下的患者。
■我们的研究包括17名患者。平均年龄5岁,极端年龄为2至11岁。我们注意到男性占主导地位,性别比(M/F)为2.4。在所有情况下,腐蚀性产品的摄入都是偶然的。苛性产物为59%的苛性钠。摄取的产品的平均量为5ml(2ml至20ml)。平均咨询时间为3天(3小时至15天)。临床上,吞咽困难是最有功能的体征,由13起案件代表,或76%。关于一般标志,3例(18%)因发烧入院;15例(88%)血压正常;2例(18%)处于休克状态。14例(82%)患者呼吸频率正常。四名患者(24%)在与严重营养不良和脱水相关的一般状况恶化的状态下入院。在体检时,2例患者(12%)在上腹部水平出现腹部防御。ENT球检查显示2例患者(12%)发生良性颊咽溃疡。4例患者(24%)进行了胃十二指肠纤维镜检查。在食道中观察到的腐蚀性病变是:Zargar阶段I为25%,50%的阶段伊拉,阶段Illb为25%。在胃里,75%的病例为ZargarI期,25%的病例为III期。对3例患者(18%)进行了胸腹骨盆计算机断层扫描(CT)注射。在一名患者中,食管壁缺乏与食管坏死相容的增强。摄入苛性碱超过72小时后,有8例患者(47%)进行了食道胃十二指肠转运。他们在3例患者中显示食管狭窄超过3厘米,2例食管多发狭窄,2例患者单发食管狭窄,和1例患者的单例无位管狭窄。治疗学上,所有患者均受益于止吐药以避免呕吐和质子泵抑制剂.对12例患者(71%)进行了第三代头孢菌素静脉抗生素预防。基于静脉泼尼松龙的皮质类固醇治疗每天1g/1.73m2的剂量用于限制或预防9例患者(53%)的狭窄。对7例患者(41%)进行了胃肠外营养治疗。2例患者(12%)进行了内窥镜扩张。对7例患者(41%)进行了急诊手术治疗:3例接受了过渡性胃造瘘术;在其他3例中,通过结肠移植进行食管成形术,1例患者接受全胃切除术相关食管剥离术治疗。一名患者的保守治疗进展良好,术后病程以结肠吻合口漏为特征。平均住院时间为5天(1-32天)。
■意外的腐蚀性摄入会产生严重的后果。防止这些事故依赖于提高公众对与这些产品的不当储存相关的危险的认识。
Caustic ingestion in children is a public health problem; it is mainly due to domestic accidents due to improper packaging and storage of caustic products. It is a medical and surgical emergency whose management is multidisciplinary. The lesions caused by the accidental ingestion of caustics can affect the functional and vital prognosis in 10% of cases.
A retrospective, descriptive study from January 2020 to December 2022 (2 years), carried out in the emergency department of the General Reference Hospital of Niamey (Niger). The study included patients less than 15 years old admitted for ingesting a caustic product.
Our study included 17 patients. The average age was 5 years, with age extremes of 2 to 11 years. We noted a male predominance with a sex ratio (M/F) of 2.4. Ingestion of caustic products was accidental in all cases. The caustic product was caustic soda in 59%. The average quantity of product ingested was 5 ml (2 ml to 20 ml). The average consultation time was 3 days (3 hours to 15 days). Clinically, dysphagia was the most functional sign, represented by 13 cases, or 76%. Regarding general signs, 3 patients (18%) were admitted with fever; blood pressure was normal in 15 patients (88%); and 2 patients (18%) were admitted in a state of shock. The respiratory rate was normal in 14 patients (82%). Four patients (24%) were admitted in a state of deterioration in the general condition associated with severe malnutrition and dehydration. On physical examination, 2 patients (12%) presented with abdominal defense at the epigastric level. Examination of the ENT sphere revealed benign buccopharyngeal ulcerations in 2 patients (12%). Esogastroduodenal fibroscopy was performed in 4 patients (24%). The caustic lesions observed in the esophagus were: Zargar stage I at 25%, stage Ila at 50%, and stage Illb at 25%. In the stomach, the lesions were Zargar stage I in 75% of cases and stage III in 25% of cases. An injected thoracic-abdominopelvic computed tomography (CT) was performed in 3 patients (18%). It revealed a lack of enhancement of the esophageal wall compatible with esophageal necrosis in one patient. An esophagogastroduodenal transit was performed in 8 patients (47%) admitted more than 72 hours after ingestion of the caustic. They showed esophageal stenoses longer than 3 cm in 3 patients, multiple esophageal stenoses in 2 patients, a single esophageal stenosis in 2 patients, and a single antropyloric stenosis in 1 patient. Therapeutically, all patients benefited from antiemetics to avoid vomiting and proton pump inhibitors. Intravenous antibiotic prophylaxis with third-generation cephalosporin was administered to 12 patients (71%). Corticosteroid therapy based on IV prednisolone at a dose of 1 g/1.73 m2 per day was used to limit or prevent stenoses in 9 patients (53%). Parenteral nutrition was administered to 7 patients (41%). Endoscopic dilations were performed in 2 patients (12%). Emergency surgical treatment was performed in 7 patients (41%): 3 patients underwent transitional feeding gastrostomies; in 3 others, esophagoplasties by colon transplant were performed, and 1 patient was treated by stripping of the esophagus associated with total gastrectomy. The postoperative course was marked by a leak of esocolic anastomosis in one patient for whom conservative treatment was performed with good progress. The average length of hospital stay was 5 days (1-32 days).
Accidental caustic ingestions can have serious consequences. Preventing these accidents relies on raising public awareness of the dangers associated with improper storage of these products.