Pediatric surgery. Treatment of esophageal injuries (most important)

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Pediatric surgery. Treatment of esophageal injuries (most important)

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19. Treatment of damage to the esophagus

A child who has received a chemical burn of the esophagus requires emergency hospitalization. In the acute stage of the disease, measures are taken to remove from the state of shock and vigorous detoxification therapy aimed at preventing or reducing the local and general effects of the poison. For this purpose, painkillers and cardiac drugs are administered to the victim, the stomach is washed through the tube. Depending on the nature of the caustic substance, washing is done either with a 0,1% solution of hydrochloric acid (with an alkali burn), or with a 2-3% solution of bicarbonate of soda (with an acid burn) in a volume of 2-3 liters. As a rule, there are no complications from the introduction of a gastric tube.

The complex of anti-shock measures, in addition to the introduction of cardiac agents and oinopon, includes intravenous infusions of plasma, glucose solution, vagosympathetic cervical novocaine blockade.

The possibility of layering secondary infection dictates the early use of antibiotic therapy.

Gastric lavage is used not only in emergency care, but also 12-24 hours after the burn. This removes the remaining chemicals in the stomach.

An important therapeutic factor is the use of hormones, vitamin therapy and the appointment of a balanced diet. In severe cases, when children refuse to drink and water, protein preparations and liquid are administered intravenously for 2-4 days to relieve intoxication and for the purpose of parenteral nutrition. To improve the general condition, the patient is prescribed oral feeding with high-calorie, chilled food, first liquid (broth, milk), and then well-mashed (vegetable soups, cottage cheese, cereals).

From the first days after the injury, children should receive one dessert spoon of vegetable or vaseline oil through their mouths, it has a softening effect and improves the passage of the lump through the esophagus.

Until recent years, bougienage has been considered the main method of treating burns of the esophagus. Distinguish between early, or preventive, bougienage and later, therapeutic - with cicatricial stenosis of the esophagus. The tactics of treatment is determined by the degree of burns of the oral cavity, pharynx and esophagus. To identify and assess the nature of the lesion and its prevalence, diagnostic esophagoscopy is performed.

Early bougienage prevents the formation of cicatricial stenosis of the esophagus. Bougienage is started from the 5-8th day after the burn.

Only special soft bougie are used. By this time, acute inflammatory changes in the wall of the esophagus subside, granulations appear, the general condition of the child improves, and the temperature returns to normal.

Bougienage is carried out without anesthesia three times a week for 1,5-2 months. During this period, the child is in the hospital.

Then he is discharged for outpatient treatment, having prescribed bougienage once a week for 2-3 months, and in the next six months - 1-2 times a month.

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

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