Pathogenesis and Pathology

Caustic ingestion can produce a progressive and devastating injury to the oesophagus and stomach. Caustic material ingestion is most frequently encountered in children who accidentally swallowed caustic materials or in adults who ingested caustic materials for suicidal purposes.1,2 Alkaline caustics and acids are the commonest chemicals implicated in caustic burns. Stricture formation with inability to swallow food after the injury is inevitable in some cases. Many different therapies have been recommended. The literature regarding the treatment of these patients is quite controversial and inconclusive. Repeated dilatations to maintain an adequate lumen diameter were given in patients with chronic strictures. In more severe strictures, due to the complications and ineffectiveness of the dilatation, surgical replacement of the oesophagus may be required. The causative caustic agent is either acid or alkali with different reactions and sequelae. The concentration and amount of the ingested material have an important impact on the injury. Lye is a broad term for a strong alkali used in cleansing agents.3 For example, sodium and potassium hydroxides in granular, paste, and liquid forms are used in drain and oven cleansers as well as washing detergents. Also, button batteries, which contain high concentrations of sodium and potassium hydroxides, can cause severe injuries. Acids are commonly available in toilet bowel cleansers (sulfuric, hydrochloric); battery fluids (sulfuric); and swimming pool and slate cleansers (hydrochloric).3 The majority of cases in Egypt are due to caustic potash, with three to five new cases every month and an overall ratio of eight alkali cases for every acid case.