Caustic Stricture of Oesophagus

Question 1

Aetiology

Answer 1

• accidental or suicidal ingestion of caustic agents (strong acid or alkali)
• mid and lower oesophagus are usually affected

Question 2

Clinical feature

Answer 2

• history of ingestion
• burning pain from mouth to stomach
• oedema of lips and glossopharynx–> airway compromise
• chemical pneumonitis: dyspnoea in the presence of aspiration
• oesophageal injury: dyspnoea and odynophagia
• shock and respiratory distress

Question 3

Investigation

Answer 3

• Early fibre-optic endoscopy (within 24 hours): to assess degree of damage to oesophagus and stomach
• nasoenteral feeding can be placed at the same time if supplemental nutrition is required

Question 4

Complication

Answer 4

• Early: airway compromise, oesophageal and gastric perforation and haematemesis
• Late: oesophageal stricture (prolonged acid reflux)

Question 5

Treatment

Answer 5

Emergency

• prompt resuscitation
• perforation: OGD with delayed reconstruction

Medical

• broad-spectrum antibiotics: aspiration pneumonitis/ perforation
• steroid: reduce stricture formation

Endoscopic dilatation of strictures
- gentle dilatation undertake >6 weeks following injury

Surgery
- oesophageal replacement using colonic interposition graft (a loop of colon/ small bowel is brought up on is vascular pedicle between the stomach below and upper oesophagus above)