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. 2001 Jan 4;119(1):10-5.
doi: 10.1590/s1516-31802001000100004.

Ingestion of caustic substances and its complications

R C Mamede  1 , F V de Mello Filho
Affiliations

Ingestion of caustic substances and its complications

R C Mamede et al. Sao Paulo Med J. .

Abstract
in English, Portuguese

Context: Caustic substances cause tissue destruction through liquefaction or coagulation reactions and the intensity of destruction depends on the type, concentration, time of contact and amount of the substance ingested.

Objectives: To analyze the complications in patients who ingested caustic substances and correlate them with the amount of caustic soda ingested.

Design: Retrospective study.

Setting: University hospital, a referral center.

Participants: A total of 239 patients who ingested caustic soda.

Main measurements: The amount of granulated caustic substance ingested was measured as tablespoonfuls and the following complications were analyzed: esophagitis, esophageal stenosis and progression to cancer, fistulas, perforations, stomach lesions, brain abscesses, and death. Stenosis was classified as mild, moderate or severe according to the radiological findings.

Results: We observed an 89.3 % incidence of esophagitis; 72.6 % of the cases involved progression to stenosis and 1 per cent died during the acute phase. Stenosis was mild in 17.6 % of cases, moderate in 59.3 % and severe in 23 %. The incidence of stenosis was 80.8 per cent in women and 62.5 % in men. The incidence of stenosis was 46.9 % in the group that ingested "fragments" and 93.6 % in the group that ingested one or more tablespoonfuls of caustic substances. Among subjects who ingested one or more tablespoonfuls, 32.2 % developed lesions of the stomach-duodenum, whereas the ingestion of "fragments" was not sufficient to induce these lesions. There was no correlation between the intensity of lesions of the esophagus and of the stomach. Progression to cancer of the esophagus occurred in 1.8 % of cases, death during the chronic phase in 1.4 %, perforations in 4.6 %, fistulas in 0.9 %, and brain abscesses in 1.4 %.

Conclusions: The complications were related to the amount of caustic soda ingested. Small amounts caused esophagitis or stenosis and large amounts increased the risk of fistulas, perforations and death.

CONTEXTO:: As substâncias cáusticas promovem a destruição dos tecidos através de reação de liquefação ou coagulação, e a intensidade de destruição depende do tipo da concentração, do tempo de contato e da quantidade ingerida.

OBJETIVOS:: Analisar as complicações observadas e correlacioná-las com a quantidade de “soda cáustica” ingerida.

TIPO DE ESTUDO:: Estudo retrospectivo.

LOCAL:: Hospital Universitário, centro de referência.

PARTICIPANTES:: 239 pacientes que ingeriram “soda cáustica”.

VARIÁVEIS ESTUDADAS:: Quantidade de cáustico granulado ingerido medido em colheres de sopa, e as complicações analisadas foram: esofagite, estenose e cancerização esofágica, fístulas, perfurações, lesões do estômago, abscesso cerebral e óbito. As estenoses foram classificadas em leve, moderada e grave, conforme os achados radiológicos.

RESULTADOS:: Observaram-se 89,3% de esofagite que em 72,6% evoluíram para estenose e 1% para óbito na fase aguda. Estenose leve foi encontrada em 17,6%, moderada em 59,3% e grave em 23%. Nas mulheres identificou-se 80,8% de estenose e no homem 62,5%. No grupo que ingeriu fragmentos houve 46,9% de estenose e no que bebeu uma ou mais colheres, 93,6%. Constatamos 32,2% de lesões no estômagoduodeno ao ingerirem uma ou mais colheres, pois a ingestão de “fragmentos” não foi suficiente para tal. Não houve, nesse estudo, correlação entre a intensidade de lesões do esôfago e do estômago. Observaram-se 1,8% de cancerização do esôfago, 1,4% de óbitos na fase crônica, 4,6% de perfurações, 0,9% de fístulas e 1,4% de abscesso cerebral.

CONCLUSÕES:: As complicações tiveram relação com a quantidade de soda cáustica ingerida; que pequenas quantidades causam esofagite ou estenose e, em grande quantidade, aumentam o risco de fístulas, perfurações e óbito.

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Conflict of interest statement

Conflict of interest: Not declared

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