PURPOSE: Endoscopy has been recommended as a primary procedure for determining the extent of damage and prognosis in patients with caustic ingestions. Endoscopy within the first 24 hours has been suggested, however, such immediate endoscopy is not always possible. Therefore, we wanted to determine complications and possible delayed sequelae after the endoscopy performed dependent on time, including less than 24 hours and more than 24 hours, after ingestion of relatively high toxic caustic agents. METHODS: From January 2005 to May 2013, 105 consecutive patients were diagnosed with caustic poisoning in the emergency department of the Wonju Severance Christian Hospital. Out of 95 patients who underwent endoscopy, while excluding 49 patients who ingested sodium hypochlorite and 15 patients due to insufficient data, 41 patients were ultimately included. We compared general characteristics, complications related to endoscopy, late sequelae, total admission length, and mortality between two groups. RESULTS: Twenty eight patients (68.3%) were diagnosed with acid ingestion. Median endoscopy time was 17.8 (IQR 9.7-36.9) hours and performed in 16 patients (39%) after 24 hours. There were no complications, such as perforation and bleeding in either endoscopy within 24 hours group or endoscopy after 24 hours group. In addition, no difference in ingested materials, endoscopy grade, or late sequelae was observed between endoscopy within 24 hours group and endoscopy after 24 hours group. CONCLUSION: No difference in complications and late sequelae was observed between endoscopy within 24 hours group and endoscopy after 24 hours group when endoscopy was performed based on a clinician's assessment.
Caustics ; Eating ; Emergency Service, Hospital ; Endoscopy* ; Gangwon-do ; Hemorrhage ; Humans ; Mortality ; Poisoning ; Prognosis ; Sodium Hypochlorite

PURPOSE: This study reports the clinical features of children and adolescents treated for acute poisoning at a regional emergency department (ED). METHODS: We retrospectively analyzed children and adolescents (under 19 years) treated for poisoning in an emergency department (ED) from 2003 to 2012. Children range from 0 to 10 years and adolescents range from 11 to 18 years. Demographic data, poisonous material data, treatment, and outcome from poisoning were collected. RESULTS: There were 742 cases of pediatric poisoning during the study period. The distribution of patient ages was bimodal, with two peaks during 1~2 years and 17~18 years of age. The proportion of adolescents with acute poisoning increased from 22.7% (years 2003~2007) to 38% (years 2008~2013). Among children less than 11 years of age, various poisonous agents and therapeutic drugs comprised 43.9% of the total toxic substance subtypes. However, four types of toxic substances dominated among adolescents: acetaminophen, carbon monoxide, corrosives, and psychiatric drugs. Overall, 54.6% of acute intoxicated patients were asymptomatic (17.7% in adolescents). In addition, 25.8% of patients who wer children were not medically treated compared to 2.8% of adolescent patients. Gastric lavage, charcoal usage, and antidote therapy were performed more often in adolescents and enhanced elimination was only performed in adolescents. The discharge rate from the emergency department was 86.8% for children and 69.1% for adolescents. Also, 4.8% of adolescents were admitted into an intensive care unit but no patients died. CONCLUSION: The incidence of adolescent poisoning increased during the period examined. There were many clinical differences in acute poisoning between children and adolescents. Therefore, strategies to cope with acute poisoning according to age group are required.
Acetaminophen ; Adolescent* ; Carbon Monoxide ; Caustics ; Charcoal ; Child* ; Emergencies* ; Gastric Lavage ; Humans ; Incidence ; Intensive Care Units ; Pediatrics ; Poisoning* ; Retrospective Studies*

OBJECTIVE: We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture. MATERIALS AND METHODS: The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5). RESULTS: A total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD. CONCLUSION: Only a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.
Acetic Acid/poisoning ; Balloon Dilatation/*methods ; Burns, Chemical/radiography/*therapy ; Caustics/poisoning ; Child ; Child, Preschool ; Deglutition Disorders/etiology ; Esophageal Stenosis/chemically induced/*radiography/*therapy ; Esophagus/radiography ; Female ; Humans ; Infant ; Lye/poisoning ; Male ; Retrospective Studies ; Treatment Outcome

Hydrogen peroxide is a commonly used oxidizing agent. If injected, it may result in morbidity via direct caustic injury, oxygen gas formation, and lipid peroxidation. We report a 40-year-old male patient who accidentally swallowed undiluted hydrogen peroxide (35%). The initial chest computed tomography scan showed no active lesions. He was admitted to the intensive care unit for conservative treatment. Fourteen days after treatment, uncontrolled fever and foul oder sputum occurred, which was not alleviated despite empirical antibiotics therapy. Findings on a chest computed tomography showed tracheo-esophageal fistula at the lower trachea and left main bronchus. He underwent surgical replacement surgery and was discharged without complication after 52 days of admission.
Adult ; Anti-Bacterial Agents ; Bronchi ; Caustics ; Fever ; Fistula* ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Intensive Care Units ; Lipid Peroxidation ; Male ; Oxygen ; Poisoning ; Sputum ; Thorax ; Trachea