The simultaneous admission of nine youths to our institution following their ingestion of concentrated
sodium hydroxide (which had been mistaken for wine) provided us with a unique opportunity to manage
corrosive esophageal
injuries ranging in severity from second-degree oral mucosal injury alone to full-thickness hypopharyngeal, esophageal, and gastric injury. The severity of injury was graded first on the basis of symptoms and physical examination of the mouth, and then in the operating room by rigid esophagoscopy. This procedure provided a logical approach to management. Three patients with second-degree oral
burns required no surgery. Six patients required
laparotomy with
gastrostomy and/or chimney feeding
jejunostomy, one required immediate esophagogastrectomy, and three required immediate total or subtotal
gastrectomy. There were no deaths. Three patients have subsequently required esophageal replacement and three others have required repeated dilatations. At 2-year followup, all nine maintain their nutritional status orally, and all except for the previously mute patient can phonate. Ingestion of liquid
lye requires a much more aggressive diagnostic and therapeutic approach than is currently recommended for ingestion of
caustics in general. On the basis of our experience with these nine patients, we suggest the following for esophageal liquid
lye injury: 1) early evaluation of the esophagus by esophagoscopy; 2) with esophageal
burns, urgent
laparotomy to assess gastric damage and
gastrostomy to pass a string for subsequent retrograde dilatations; 3) adequate resection of stomach for gastric
burns; 4) with deep esophageal
burns, early
esophagectomy.