CONTROVERSIES IN THE APPROACH TO CAUSTIC INGESTIONS

The records of 449 children younger than 15, consecutively admitted in a four year period to 6 Pediatric Emergency Department with a history of acid or alkaline ingestion, have been reviewed. Signs and symptoms were present in 193, the most common beeing oropharingeal lesions, vo miting, drooling. Esophagoscppy was performed in a) patients; an esoph ageal damage was seen in 45, but esophageal bums of a degree higher th an first were present in only 15. Two of them, both with a third degre e lesion, developed an esophageal stricture. The number of substances able to cause more than a superficial mucosa injury (2(nd) and 3(rd) d egree) was very small: most of them were very strong alkalies (pH > 12 ) or, much less often, very concentrated strong acid Oropharingeal les ions and precocious single symptom were not correlated with the presen ce of severe esophageal burns that instead seem to be more adequately predicted from the presence of at least two sings and symptoms, fromth eir severity and expecially from their prolonged duration (12-24 hours ). We think therefore that the decision to perform an esophagoscopy ha s to be taken on the basis of: 1) the characteristics of the ingested substance and 2) the clinical data, also evaluated 12-24 hours after t he ingestion.