dr. A. A. SAGUNG PUTERI, Sp.

THT-KL

Definition

Esophageal

inflammation,

caused by
burn, trauma due to ingested
the
corrosive chemical agents.

Three categories of chemical agent :

1. Acid ( Corrosive agent ) pH < 7
Sulphuric Acid, Toilet bowl cleaner,
Battery fluid.
2. Alkali ( Caustic agent ) pH > 7
Clinitest tablet, Laundry detergent
3. Bleaches pH = 7
Sodium hypochlorate

Corrosive Agent
Alkali

Natrium hydroxide
Kalium hydroxide
Ammonium
Hydroxide
Natrium carbonate

Drain cleaners
Oven cleaners
Household
cleaners
Laundry detergent

Acid

Phosphoric acid
Sulfuric acid
Oxalat

Toilet bowl
cleaners
Battery
Liquid plumber

Bleache Sodium
s
hypochlorate

Bayclean

Pathology
Acid Buffer

Alkali
Buffer

Bleaches

Pathologic
al damages
Mucosal
penetratio
n

Coagulation
Necrotic

Liquefaction
Necrotic

Esophageal
irritation

Superficial
mucosal
penetration
damaged

Deep mucosal
penetration
damaged

Mucosal
esophageal
irritation

Severity of
damages

If reached the
gaster, can
cause more
severe
damaged
(perforation &
gastric
stricture)

Usually cause
more severe
damage in the
esophagus

Not affect the

morbidity and
mortality
significantly

Pathology
Burn

trauma on mucosal surface

not cause sequele
Burn trauma that affected the sub
mucosal &/ muscular tissue induce
inflammation & fibrotic process
new fibrous tissue formation
stricture.

Pathology
Corrosive agents
Hipotension of lower esophageal sphincter
Pyloric spasm
Reflux / regurgitation of gastric contents into
esophagus
Cricopharyngeal muscle spasm
Propulsion the content back to gaster

Incidence
Child

: accidentally swallowed
Adults : Suicide attempt

Symptoms
The severity of the symptoms depend on:
Types
Volume
of agent ingested
Concentration
The presence of other food in stomach
Gastrointestinal transient time
Attempt to drink the corrosive agents
The presence of gastro esophageal reflux
The damage can be more severe if the content is
spitted out, due to 2 times contact with the
esophageal mucosa.

Symptoms
Based

on the time of the initial complaints:

Acute phase : 1-3 days after the ingestion.
dysphagia, fever, abdominal &
retrosternal pain.
Latent phase ( intermediate ): 2-6 weeks
after the ingestion.
no complaints, although stricture might be
happen if treatment not adequate.
Chronic phase ( obstructive ) : 1-3 years
after the ingestion.
Recurrent disphagia may be happened
due to stricture formation if the treatment
is not adequate.

Gradation of Burn
SYMPTOM
Grade
1
Grade
2
Grade
3

No sympton

ESOPHAGOSCOP
Y
Erythema, oedem

Burn of lips oral Erytheme,

cavity,
ulceration
dysphagia
- Ulcelation until
Severe burn,
dysphagia
peri esophageal
Retrosternal &
tissue
abdominal pain - Obliteration of

Diagnosis
History of corrosive agents ingestion
Symptoms
Physical examination :
Burn lesion in oral cavity & pharynx
Accumulation of saliva in oral cavity
Ancillary procedures :
Laboratorium : complete blood test
and electrolytes
Thorax X-ray ( AP, Lat)
Esophagoscopy

Management

Neutralization with water, milk, eggs,

antacid.

Induces vomiting with emetic drugs The

Gastric lavage
absolute
contraindication
Rehidration:
Aminofuchsin infusion
Nacl 0.9%
Dextrose 10%
Kcl

Management
Application

of nasogastric tube
To maintain intake
To prevent the contact of esophageal
lesion to ingested foods.
Medical treatments:
Antibiotic for 2-3 weeks &/ 5 days
without fever
Corticosteroid : 1-2 mg/kg body
weight for 21 days (most effective in
grade 2)
Analgetic : IV/IM/Suppositoria

Follow up
Esophagography

or esophagoscopy
after 3 weeks & repeat again after
2 months.
To reevaluate the present of
stricture formation.
If mild stricture present dilatation
& aplication of esophageal stent
if multiple stricture present
gastrotomy -retrograde dilatation

Complications
Laryngeal

edema
Aspiration pneumonia
Mediastinitis
Perforation in esophagus
Tracheo-esophageal fistula
Stricture