Document Type : Case Report
Authors
Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine, Alexandria University, Egypt
Abstract
Background: Ingestion of corrosive chemicals is a major problem, especially in developing countries. Ingestion may be deliberate as suicide attempts (mostly in adolescents and adults) or accidental (mostly in children).
Case presentation: A 50-year-old male patient was brought to the APC – he was suffering from vomiting following ingestion of NaOH. On examination: he complained of severe dysphagia, drooling, hoarseness of voice, severe pain, and a burning sensation in his mouth. The vital signs were heart rate of 100 beats /minute, blood pressure 140/90 mmHg, temperature 37°C, respiratory rate of 26/min, and GCS was 15. The patient was stabilized on intravenous treatment and NBO. Follow-ups were carried out for all vital signs, and laboratory tests were carried out, with an initial improvement in his condition. After 6 days, the patient vomited vigorously, and tissues extruded from his mouth, where a complete sloughing of esophageal mucosa occurred. The patient was transferred to the cardiothoracic department where they decided to maintain conservative treatment and NBO for 2 weeks. Later, the patient was prepared for gastrostomy followed by colon transposition. The patient improved and was discharged with a follow-up regimen.
Discussion: Esophagitis Dissecans Superficialis (EDS) is a rare esophageal lesion characterized by sloughing of the esophageal mucosa, there is limited information on EDS resulting from corrosive poisoning. Endoscopy was not performed for fear of perforation and CT was carried out instead of endoscopy. Patients usually have an excellent response to treatment, with proton pump inhibitors and steroids. These are the same management lines that followed before surgical intervention. The surgeons perform an esophagectomy and colonic transposition on the patient to avoid stricture in the future. This is considered an acceptable treatment.
Conclusion: Clinical toxicologists should be expecting esophageal sloughing as one of the corrosive ingestion complications within a week of ingestion.
Keywords
Main Subjects
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