Corrosive upper gastrointestinal strictures in children: Difficulties and dilemmas

Table 1 Commonly ingested corrosives in children

Acid
Sulfuric acid	Batteries, industrial cleaning agents, metal plating, toilet cleaner
Hydrochloric acid	Solvents, metal cleaners, lime solvents, toilet and drain cleaners, muriatic acid, antirust compounds
Acetic acid	Pickling vinegar, vinegar spirit, wart solution
Phosphoric acid	Toilet cleaners
Oxalic acid	Paint thinners, metal cleaners, toilet cleaner
Alkali
Sodium hydroxide	Grease/oil cleaners, drain cleaners, sink openers, oven cleaners, oil removers
Potassium hydroxide	Oven cleaners, washing powders, paint remover
Sodium carbonate	Soap manufacturing, fruit drying on farms
Sodium hypochlorite	Household bleaches
Ammonium hydroxide	General cleaner and grease remover
Miscellaneous
Hydrogen peroxide	Surface and food cleaner
Potassium permanganate	Disinfectants, hair dyes

Table 2 Clinical features of corrosive ingestion

Symptoms of acute corrosive ingestion
Organ system
Skin	Burning sensation and pain on face, mostly perioral
Respiratory tract	Cough, difficulty in breathing, aphonia or dysphonia, chest pain, cynosis. Aspiration of large volume of corrosive may lead to endobronchial inflammation, necrosis and mediastinitis
Gastrointestinal tract	Oral burn, hypersalivation, nausea, vomiting (with or without blood), retrosternal and upper abdomen pain, dysphagia. Rarely perforation of gastrointestinal tract may happen and present with abdominal distension, tenderness and rigidity
Symptoms after gastrointestinal stricture formation
Esophageal	Vomiting, dysphagia, hematemesis, acute obstruction due to food impaction at stricture site, growth failure
Pyloric	Non-bilious stale food vomiting, upper abdominal distension, growth failure

Table 3 Zargar classification for corrosive esophageal injury

Zargar classification
Grade 0	Normal examination
Grade 1	Edema and hyperemia of the mucosa
Grade 2
2a	Friability, hemorrhages, erosions, blisters, whitish membranes, exudates and superficial ulcerations
2b	Grade 2a plus deep discrete or circumferential ulceration
Grade 3
3a	Multiple ulcerations and areas of necrosis (areas of brown-black or grayish discoloration were taken as evidence of necrosis)
3b	Small scattered areas of necrosis; extensive necrosis