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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Corrosive esophageal injuries in children. A shortlived experience in Sierra Leone
International Journal of Pediatric Otorhinolaryngology, Volume 71, No. 10, Year 2007
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Description
Objective: Children with caustic ingestions in developing countries are often treated at home, sometimes by traditional healers, or are referred, frequently late, to tertiary hospitals, which only seldom offer adequate endoscopic and dilatation facilities. Therefore, when dilatations are performed, the stricture is often already well established, making dilatation more difficult. The aim of this paper is to report our experience in the management of corrosive injuries in a group of children of Sierra Leone, all complaining accidental ingestion of caustic soda, many of them treated months after the ingestion. Method: We considered all children admitted after corrosive ingestion, from November 2001 to November 2005, to the "Emergency" Surgical Center in Goderich-Freetown, Sierra Leone. In December 2005 the hospital was supplied with endoscopes and dilatation devices. The children still followed up clinically were recalled to submit them to an endoscopic follow-up and to a dilatation, if needed. Results: Forty children were admitted (mean age: 4.5 years): 16 (group A) after an esophageal perforation during dilatation performed elsewhere (death rate: 56%). Twenty-four children (group B) were observed after ingestion, 58% being submitted to a surgical gastrostomy. Death rate after ingestion was nil. The mean interval between ingestion and endoscopy was 8.8 months. Fifty-three dilatations were carried out in 17 children over a 3 months period. We report three perforations (17.6%) and a death rate of 5.8% (1/17). Two patients were lost to follow-up. Three patients (17.6%) did not show any improvement. Four children complained recurrent dysphagia after the first dilatation cycle. Overall, 10 children (58.8%) showed a clear-cut improvement at 6 months. Conclusions: The majority of treated strictures were late, therefore difficult to dilate and at higher risk of perforation. Dilatation with Savary bougies seems safer than with balloon catheters. Recurrent strictures and a long-term dilatation treatment should be expected. Retrograde dilatations through gastrostomies should be the preferred method of treatment and surgical gastrostomies should be performed without hesitation. Esophageal replacement is unlikely in these countries, except in very few referral centres. Therefore, any effort should be made to treat caustic strictures by timely dilatation programs. © 2007 Elsevier Ireland Ltd. All rights reserved.
Authors & Co-Authors
Contini, Sandro
Italy, Parma
Università Di Parma
Tesfaye, Makonnen
Ethiopia, Addis Ababa
Addis Hiwot General Hospital
Picone, Piero
Italy, Viterbo
Ospedale Di Belcolle - Viterbo
Pacchione, Dario
Italy, Ascoli Piceno
Villa Anna Hospital
Kuppers, Beate
Italy, Pisa
Azienda Ospedaliero Universitaria Pisana
Zambianchi, Carlo
Sierra Leone
Emergency Surgical Center
Scarpignato, Carmelo
Italy, Parma
Università Di Parma
Statistics
Citations: 43
Authors: 7
Affiliations: 6
Identifiers
Doi:
10.1016/j.ijporl.2007.07.007
ISSN:
01655876
Research Areas
Health System And Policy
Maternal And Child Health
Violence And Injury
Study Design
Cohort Study
Study Locations
Sierra Leone