Presentation
Severe dysphagia for solids and liquids. History of corrosive intake 4 months ago.
Patient Data
Long, irregular stricture involving mid and lower esophagus with lack of normal distension of the esophagus.
Case Discussion
Initial assessment of caustic esophageal injury involves clinical assessment, laboratory studies, endoscopic examination, and possibly imaging studies to grade the severity of the injury and ultimately guide management.
Chest radiographs are helpful in the initial and ongoing assessment of patients with a caustic injury, paying particular attention for mediastinal air and pleural effusions that could suggest perforation.
With the availability of high-resolution endoscopy and cross-sectional imaging, esophagrams are not likely required in the initial assessment, and instead can be used very selectively in the later course to characterize strictures or assess for delayed perforations. CT scans are used increasingly to assess these patients and for prognostic purposes.
Minor injuries are typically treated with a trial of oral intake, moderate injuries require close monitoring in a hospital setting, and severe injuries typically require surgical intervention. Long-term complications include recurrent stricturing and development of malignancy.