Kostik Madde Kullanımına Bağlı Özofagus Yaralanması Tanı ve Tedavi
Özet
Kostik madde alımı, çocuklarda kazara, yetişkinlerde ise genellikle kasıtlı olarak meydana gelen ve sindirim sisteminde ciddi hasarlara yol açabilen önemli bir sağlık sorunudur. Yaralanmanın şiddeti; kimyasalın pH değeri, konsantrasyonu ve temas süresi gibi faktörlere bağlıdır; alkaliler likefaksiyon, asitler ise pıhtılaşma nekrozuna neden olur. Klinik değerlendirmede anamnez ve fizik muayene kritik rol oynarken, solunum ve dolaşım stabilizasyonu ilk önceliktir. Hasarın objektif derecelendirilmesi ve tedavi algoritmasının belirlenmesi için esnek endoskopi ve bilgisayarlı tomografi (BT) altın standart olarak kabul edilir. Hafif yaralanmalar ayaktan izlenebilirken, orta ve ciddi olgularda hastaneye yatış, intravenöz hidrasyon, antibiyotik ve duruma göre kortikosteroid tedavisi uygulanır. Transmural nekroz veya perforasyon saptanan yüksek evreli (Grade 3b ve üzeri) hastalarda acil cerrahi müdahale ile nekrotik dokuların çıkarılması hayat kurtarıcıdır. Erken dönem tedavisinin ardından hastaların %70-90'ında cerrahi gerekmez ancak uzun vadede striktür (darlık), fistül, kanama ve özofagus kanseri gibi ciddi komplikasyonlar gelişebilir. Özellikle dirençli darlıklarda endoskopik dilatasyon, stent uygulamaları veya kolon interpozisyonu gibi karmaşık özofageal rekonstrüksiyon cerrahileri gerekebilir ve hastaların yaşam boyu düzenli endoskopik takibi hayati önem taşır.
Caustic substance ingestion is a major health problem that occurs accidentally in children and usually intentionally in adults, leading to severe damage in the digestive system. The severity of the injury depends on factors such as the pH value, concentration, and contact time of the chemical; alkalis cause liquefaction necrosis, while acids cause coagulation necrosis. While history and physical examination play a critical role in clinical evaluation, respiratory and circulatory stabilization is the primary priority. Flexible endoscopy and computed tomography (CT) are considered the gold standard for objective grading of damage and determining the treatment algorithm. While mild injuries can be monitored on an outpatient basis, moderate and severe cases require hospitalization, intravenous hydration, antibiotics, and conditional corticosteroid therapy. Emergency surgical intervention to remove necrotic tissues is life-saving in high-grade patients (Grade 3b and above) with transmural necrosis or perforation. Following early treatment, surgery is not required in 70-90% of patients, but serious long-term complications such as strictures, fistulas, hemorrhage, and esophageal cancer may develop. Especially in refractory strictures, complex esophageal reconstruction surgeries such as endoscopic dilation, stenting, or colon interposition may be required, and lifelong regular endoscopic follow-up of patients is of vital importance.
Referanslar
Sarioglu-Buke A, Corduk N, Atesci F, Karabul M, Koltuksuz U. A different aspect of corrosive ingestion in children: socio-demographic characteristics and effect of family functioning. Int J Pediatr Otorhi- nolaryngol. 2006 ve 70(10):1791-1798.
Havanond C, Havanond P. Initial signs and symptoms as prognostic indicators of severe gastrointestinal tract injury due to corrosive ingestion. J Emerg Med. 2007 ve 33(4):349-353.
Gorman RL, Khin-Maung-Gyi MT, Klein-Schwartz W, et al. Initial symptoms as predictors of esophageal injury in alkaline corrosive ingestions. Am J Emerg Med. 1992 ve 10(3):189-194.
Gupta SK, Croffie JM, Fitzgerald JF. Is esophagogastroduodenos- copy necessary in all caustic ingestions? J Pediatr Gastroenterol Nutr. 2001 ve 32(1):50-53.
Cheng YJ, Kao EL. Arterial blood gas analysis in acute caustic ingestion injuries. Surg Today. 2003 ve 33(7):483-485.
Bonnici KS, Wood DM, Dargan PI. Should computerised tomography replace endoscopy in the evaluation of symptomatic ingestion of corrosive substances? Clin Toxicol (Phila). 2014 ve 52(9):911-925.
Zargar SA, Kochhar R, Mehta S, Mehta SK. The role of fiber- optic endoscopy in the management of corrosive ingestion and modified endoscopic classification of burns. Gastrointest Endosc. 1991 ve 37(2):165-169.
Bosnali O, Moralioglu S, Celayir A, Pektas OZ. Is rigid endoscopy necessary with childhood corrosive ingestion? A retrospective comparative analysis of 458 cases. Dis Esophagus. 2016 ve 30(3):1-7.
Chiu HM, Lin JT, Huang SP, Chen CH, Yang CS, Wang HP. Predic- tion of bleeding and stricture formation after corrosive ingestion by EUS concurrent with upper endoscopy. Gastrointest Endosc. 2004 ve 60(5):827-833.
Kamijo Y, Kondo I, Kokuto M, Kataoka Y, Soma K. Miniprobe ultrasonography for determining prognosis in corrosive esophagitis. Am J Gastroenterol. 2004 ve 99(5):851-854.
Endosc, Park KS. Evaluation and management of caustic injuries from ingestion of acid or alkaline substances. Clin ve 47:301–307.
Bautista A, Tojo R, Varela R, et al. Effects of prednisolone and dexamethasone on alkali burns of the esophagus in rabbit. J Pediatr Gastroenterol Nutr 1996 ve 22:275–283.
Fulton JA, Hoffman RS. Steroids in second degree caustic burns of the esophagus: a systematic pooled analysis of fifty years of human data: 1956- 2006. Clin Toxicol (Phila) 2007 ve 45:402–408.
Usta M, Tu¨lay E, Cokugras FC, et al. High dose methylprednisolone in the management of caustic esophageal burns. Pediatrics 2014 ve e1524., 133:e1518–.
Millar AJW, Cox SG. Caustic injury of the esophagus. Pediatr Surg Int 2015 ve 31:111–121.
Cakal B, Akbal E, Ko¨ klu¨ S, et al. Acute therapy with intravenous omeprazole on caustic esophageal injury: a prospective case series. Dis Esophagus 2013 ve 26:22–26.
B Andreoni, ML Farina, R Biffi, C Crosta Esophageal perforation and caustic injury: emergency management of caustic ingestion Dis Esophagus, 10 (1997), pp. 95-100.
K Ramasamy, VV Gumaste Corrosive ingestion in adults J Clin Gastroenterol, 37 (2003), pp. 119-124.
P Zerbib, B Voisin, S Truant, et al. The conservative management of severe caustic gastric injuries Ann Surg, 253 (2011), pp. 684-688.
M Chirica, M Resche-Rigon, NM Bongrand, et al. Surgery for caustic injuries of the upper gastrointestinal tract Ann Surg, 256 (2012), pp. 994-1001.
M Lefrancois, S Gaujoux, M Resche-Rigon, et al. Oesophagogastrectomy and pancreatoduodenectomy for caustic injury Br J Surg, 98 (2011), pp. 983-990.
B Benjamin, R Agueb, H Vuarnesson, et al. Tracheobronchial necrosis after caustic ingestion Ann Surg, 263 (2016), pp. 808-813.
P Cattan, N Munoz-Bongrand, T Berney, B Halimi, E Sarfati, M Celerier Extensive abdominal surgery after caustic ingestion Ann Surg, 231 (2000), pp. 519-523.
P Zerbib, B Voisin, S Truant, et al. The conservative management of severe caustic gastric injuries Ann Surg, 253 (2011), pp. 684-688.
R Kochhar, KS Poornachandra, P Puri, et al. Comparative evaluation of nasoenteral feeding and jejunostomy feeding in acute corrosive injury: a retrospective analysis Gastrointest Endosc, 70 (2009), pp. 874-880.
L Bonavina, M Chirica, O Skrobic, et al. Foregut caustic injuries: results of the world society of emergency surgery consensus conference World J Emerg Surg, 10 (2015), p. 44.
YL Tseng, MH Wu, MY Lin, WW Lai Massive upper gastrointestinal bleeding after acid-corrosive injury World J Surg, 28 (2004), pp. 50-54.
V Gupta, KC Kurdia, A Sharma, AK Mishra, TD Yadav, R Kochhar Tracheoesophageal fistula in adults due to corrosive ingestion: challenges in management Updates Surg, 67 (2015), pp. 75-81.
YL Tseng, MH Wu, MY Lin, WW Lai Outcome of acid ingestion related aspiration pneumonia Eur J Cardiothorac Surg, 21 (2002), pp. 638-643.
AJ Millar, SG Cox Caustic injury of the oesophagus Pediatr Surg Int, 31 (2015), pp. 111-121.
L Bonavina, M Chirica, O Skrobic, et al. Foregut caustic injuries: results of the world society of emergency surgery consensus conference World J Emerg Surg, 10 (2015), p. 44.
S Contini, C Scarpignato Caustic injury of the upper gastrointestinal tract: a comprehensive review World J Gastroenterol, 19 (2013), pp. 3918-3930.
M Berger, B Ure, M Lacher Mitomycin C in the therapy of recurrent esophageal strictures: hype or hope? Eur J Pediatr Surg, 22 (2012), pp. 109-116.
M Chirica, N Veyrie, N Munoz-Bongrand, et al. Late morbidity after colon interposition for corrosive esophageal injury: risk factors, management, and outcome. A 20-years experience Ann Surg, 252 (2010), pp. 271-280.
M Chirica, MD Brette, M Faron, et al. Upper digestive tract reconstruction for caustic injuries Ann Surg, 261 (2015), pp. 894-901.
JD Knezevic, NS Radovanovic, AP Simic, et al. Colon interposition in the treatment of esophageal caustic strictures: 40 years of experience Dis Esophagus, 20 (2007), pp. 530-534.
M Chirica, H Vuarnesson, S Zohar, et al. Similar outcomes after primary and secondary esophagocoloplasty for caustic injuries Ann Thorac Surg, 93 (2012), pp. 905-912.
N Ananthakrishnan, M Nachiappan, KS Subba Rao Island pectoralis major myocutaneous flap for pharyngo-oesophageal strictures prior to oesphagocoloplasty J R Coll Surg Edinb, 46 (2001), pp. 202-204.
PE de Delva, CR Morse, WG Austen Jr, et al. Surgical management of failed colon interposition Eur J Cardiothorac Surg, 34 (2008), pp. 432-437.
