Corrosive substance ingestion in children: clinical features, management and outcomes in a tertiary care setting

Abstract

Objective: Corrosive substance ingestion remains a significant public health issue in children, often associated with insufficient preventive practices. This study aimed to evaluate the clinical presentation, endoscopic findings, clinical course, and treatment outcomes of pediatric patients admitted to our hospital after corrosive ingestion.

Materials and methods: A total of 311 children who presented to our center with caustic ingestion between January 2007 and December 2024 were included in the study. Clinical, demographic, endoscopic, and treatment outcomes were retrospectively reviewed using medical records.

Results: The mean age of the patients was 4.4 ± 4.5 years (range, 6 months-17 years), and 55.9% were male. Accidental ingestion accounted for 92.2% of cases, whereas eight adolescents ingested the substance with suicidal intent. Household cleaning products were the most frequently ingested substances (77.0%), mainly bleach (29.9%) and nitric‑acid‑based descalers (12.2%). The most severe esophagogastric injuries were associated with sodium‑hydroxide drain openers, fat removers, and nitric‑acid descalers. Endoscopic evaluation was performed in 221 children (71.1%), and repeat endoscopy was required in 35 (11.3%). Fifteen children (4.8%) who developed esophageal strictures underwent endoscopic balloon dilatation, and two required surgical gastrostomy with esophageal repair. No mortality occurred, but five patients developed major complications, including pyloric stenosis, esophageal perforation with pneumomediastinum, and brain abscess.

Conclusion: Accidental ingestion of household cleaning substances due to unawareness or negligence can lead to severe morbidities in children. Raising parental awareness is crucial to prevent such incidents.

What is known: • Corrosive substance ingestion in children is a preventable public health problem, most commonly caused by accidental exposure to household cleaning products. • The severity of injury depends on factors such as pH, concentration, physical form of the substance, and time to presentation, but symptoms do not always correlate with endoscopic findings.

What is new: • In our cohort of 311 children, acid ingestion-though less frequent-was associated with higher rates of symptoms, endoscopic evaluation, and repeat endoscopy compared with alkali ingestion. • Rare but serious complications, such as brain abscess after esophageal perforation, can occur despite the absence of mortality, underlining the need for improved prevention strategies and stricter regulations.

Keywords: Child; Corrosive ingestion; Endoscopy; Esophageal burns; Esophageal stricture; Household cleaning substances.