Year 2022 Vol. 30 No 3

PEDIATRIC SURGERY

A.N. VORONETSKY 1, A.V. HULENKA 2

CAUSTIC ESOPHAGEAL INJURY IN CHILDREN, DELAYED OUTCOMES AND SUBSEQUENT SURGICAL INTERVENTION

Belarusian State Medical University 1, Minsk, Belarus
N. N. Alexandrov National Nancer Centre of Belarus 2, Minsk,
Republic of Belarus

Objective. To find out the reasons of the ineffectiveness of dilatation therapy for post-burn stricture of the esophagus in children on the basis of pathohistological examination of esophageal samples after its subtotal resection or extirpation
Methods. The article comprises five clinical cases of children aged 1 year 3 months to 2 years 10 months with a chemical burn of the esophagus as a result of accidental swallowing of caustic materials. In all children a complication of a caustic burn resulted in refractory esophageal stricture (a length of 3.0 to 9.0 cm). The method of treatment of stricture dilatation were the followings: balloon dilatation, suture bougienage, laser recanalization, and esophageal stent insertion. Due to balloon dilation is largely ineffective in the treatment of corrosive strictures, the children underwent a surgical operation esophageal subtotal resection in 2 children and esophageal extirpation - in 3 children. The operation was performed in the period from 2 years 20 months to 4 years 7 months from onset disease. Esophageal surgical specimens were examined histologically with hematoxylin-eosin staining and Massons method.
Results. Sodium (potassium) hydroxide and sodium hypochlorite are considered to be the most common aggressive caustic substances of household cleaning agents, that cause refractory esophageal burns in children. A severe caustic burn of the esophagus results in an extended severe esophageal stricture resistant to dilatation therapy. Pathohistological examination of esophageal tissue samples after subtotal resection or extirpation of the esophagus in children with extended post-burn esophageal stricture detected displacement of the muscle layer of the esophageal wall by connective tissue, glands atrophy, epithelial necrosis, mucosal atrophy, and diffuse sclerosis with increased wall thickness of entire organ.
Conclusion. Sclerosis of the esophageal wall due to caustic burn is considered to be the reason of failed dilatation in patients with acid-induced corrosive esophageal stricture and is associated with significant morphological, anatomical and functional disorders of the esophagus.

Keywords: caustic, stricture, endoscopy, esophagoplasty, children
p. 270-280 of the original issue
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Address for correspondence:
220116, Republic of Belarus, Minsk,
Dzerzhinsky Ave., 83,
Belarusian State Medical University,
Department of Pediatric Surgery,
tel. mob.: +375 029 32-902-32,
e-mail: anvoron@mail.ru,
Voronetsky Alexander N.
Information about the authors:
Voronetsky Alexandr N., PhD, Associate Professor of the Department of Pediatric Surgery, Belarusian State Medical University, Minsk, Republic of Belarus
https://orcid.org/0000-0001-7091-376X
Hulenka Aleh V., Pathologist, Department of Pathology, Republican Scientific and Practical Center of Oncology and Medical Radiology named after A.I. N.N. Aleksandrova, Minsk, Republic of Belarus
https://orcid.org/0000-0003-3753-4340
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