Injury (Esophagus): Corrosive

DEFINITION:

EPIDEMIOLOGY:

Approximately 26,000 caustic ingestions occur per year; suicidal gesture is most common and most injurious compared to accidental ingestion
Approximately 80% of caustic ingestions occur accidentally in children less than 5 y/o, who most often consume household cleaners

ETIOLOGIES:

Severity of damage depends on corrosive properties and concentration of ingested agents
Alkaline cleaning products = most severe injury
Alkali esophagitis (i.e. Lye): upon exposure to esophagus, result in liquefactive necrosis: complete destruction of entire cells and membranes; Phases of injury:
- Acute (day 1-4): Liquefactive necrosis: sloughing or ulcer not apparent <24 hr, vascular thrombosis, inflammation
- Subacute (day 5-14): Sloughing of casts: esophageal wall is thinnest, granulation, fibroblast/collagen deposition
- Cicatrization (day 15-3 mon): Fibroblast proliferate, further collagen deposition, stricture formation, epithelialization

Acid esophagitis: coagulation necrosis with clumping and opacification of cellular cytoplasm, retained cell boundaries, unlike alkali injury

Class	Caustic Agent	Product
Strong Alkalis	Ammonia	Cleaning products
	Lye (Sodium hydroxide, Potassium hydroxide)	Disc batteries, drain cleaners, nonphosphate detergents, paint removers, washing powders
Strong Acids	Hydrochloric acid	Muriatic acid, soldering fluxes, swimming pool cleaners, toilet bowel cleaners
	Nitric acid	Gun barrel cleaners
	Oxalic acid	Antirust compounds
	Phosphoric acid	Toilet bowel cleaners
	Sulfuric acid	Battery acid, Toilet bowel cleaners
Miscellaneous	Sodium hypochlorite	Liquid bleach
Reprinted with permission from McNally P: GI/Liver Secrets 3rd ed. Elsevier/Mosby, 2006:60.