Pediatric surgery. Damage to the esophagus. Chemical burns. Clinic (most important)

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Pediatric surgery. Damage to the esophagus. Chemical burns. Clinic (most important)

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18. Damage to the esophagus. Chemical burns. Clinic

In children, damage to the esophagus is relatively rare, occurring mainly due to chemical burns or perforation of the organ wall.

The severity of the esophageal burn and the degree of its pathological and anatomical changes depend on the amount and nature of the chemical swallowed by the child.

When exposed to acids, the depth of damage to the esophageal wall is less than when exposed to alkalis. This is due to the fact that acids, neutralizing the alkalis of tissues, coagulate the protein of the cells and at the same time take away water from them.

As a result, a dry scab is formed, which prevents the penetration of acids into the depths. The impact of alkalis on tissues is accompanied by colliquat necrosis. The absence of a scab leads to a deep penetration of the caustic substance into the tissues and damage them.

There are three degrees of burns of the esophagus: light, medium and heavy.

Mild degree characterized by damage to the mucous membrane of the type of desquamative esophagitis. At the same time, hyperemia, edema and areas of superficial necrosis are noted. The inflammatory process subsides and epithelialization occurs within 7-10 days. The resulting superficial scars are elastic, do not narrow the lumen of the esophagus and do not affect its function.

With an average degree deeper lesions. Necrosis extends to all layers of the organ. After 3-6 weeks (as necrotic tissues are rejected), the wound surface is covered with granulations and then scarred. The depth and prevalence of cicatricial changes depend on the severity of damage to the esophageal wall.

A severe degree is characterized by deep and extensive damage to the esophagus with necrosis of all layers of its wall. The burn is accompanied by mediastinitis.

clinical picture

The clinical picture of a burn of the esophagus depends on the nature of the substance that caused the burn and the degree of damage to the esophagus. From the first hours after the burn, the condition of the children was severe.

As a result of rapidly growing inflammation, profuse salivation is noted, often repeated and painful vomiting. From the moment of contact with a caustic substance, there is a burning pain in the mouth, in the pharynx, behind the sternum and in the epigastric region.

Three periods are distinguished in the clinical course of the disease. The first period is characterized by acute inflammation of the mucous membrane of the mouth, pharynx and esophagus.

This condition often lasts up to 10 days, and then improves, pain disappears, swelling decreases, temperature normalizes, esophageal patency is restored - children begin to eat any food. The acute stage gradually passes into the asymptomatic period. The apparent well-being sometimes lasts up to 4 weeks.

3-6 weeks after the burn, a period of scarring begins. Gradually, the phenomena of obstruction of the esophagus increase. In children, vomiting occurs, retrosternal pains join.

X-ray examination with a contrast agent during the scarring period reveals the nature, degree and extent of the pathological process.

Authors: Drozdov A.A., Drozdova M.V.

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