Diagnostika a léčba poleptání jícnu v dětském věku

Diagnostics and Therapy of Esophagus Etching at the Child Age

Patients with the diagnosis of suspect etching esophagus form 15% of all acute admission to the hospital ofpatients at our clinic. In view of severity of the affection, possible consequences and complications the authorsconsider early diagnostic and therapeutic measures of primary importance in all cases of suspected intake(swallowing) of corrosive compounds to be performed at a specialized ORL workplace. Such ward should disposewith an emergency workplace experienced with poisonings and a surgical workplace where operations on thethoracic part of esophagus have been made. Basic procedures include especially an early rigid esophagoscopy forthe determination of the degree of etching; flexible esophagoscopy is considered risky. The esophagoscopic findingsmake it possible to classify etching into for degrees: patients with etching of the first degree are only underobservation, while the findings of 2nd and 3rd degree are indicated for introduction of nasogastric probe for theperiod of six weeks, two-stage corticoid therapy and administration of intravenous antibiotics in the first weekafter injury. In cases of 4th degree etching the probe is left for a longer period of time, the esophagus lumen ismaintained as wide as possible and collaboration with the surgeon is taken into account as well as most suitabletime for esophagus replacement.Edema of the larynx entrance is the most frequent acute complication of esophagus etching,whichmust be treated,in cases of insufficient pharmacological intervention, with intubation, while free access into respiratory pathwaysshould be secured by tracheotomy exceptionally. Post/corrosive stricture is themost frequent late complication, but itmostly reacts well to balloon dilatation. Extensive stricture limiting the esophagus lumen and thereby worsening foodintake, which cannot be successfully treated with balloon dilatation, are indicated for esophagus replacement.Mediastinitis and aortal-esophagus fistula is the most severe complication in the region of thorax.The prognosis of patients with esophagus etching of 1st to 3rd degree is generally favorable. The etching of IVthdegree is a serious life-threatening condition. The present diagnostic-therapeutic procedures ensue from publishedresults of research.

Key words:
etching, children, rigid esophagoscopy