Outcomes of the injured oesophagus in children managed at Charlotte Maxeke Johannesburg academic hospital

Abstract

BACKGROUND Caustic and foreign body related oesophageal injuries impose a significant burden of disease amongst children in developing countries. OBJECTIVES To determine outcomes and complications of caustic and foreign body ingestion in the study setting. METHODS. A retrospective record-based review of all children under 16 years of age admitted to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from June 2010 to June 2016 with a history of caustic or foreign body ingestion was performed. Statistical analysis was performed using the Chi-squared and Fischer’s Exact tests where appropriate. Data was analysed using SAS software. Ethics clearance was obtained (M1660660). RESULTS. 188 patients with caustic or foreign body ingestion were identified. Of these, 10 patients (10/188, 5.3%) were excluded as their records were lost. The majority of foreign bodies ingested were coins (55.1%, 98/178), followed by button batteries (13.5%, 24/178). Approximately one quarter of patients (24.2%, 43/178) presented with caustic ingestion. The majority of patients (81%, 144/178) suffered no complications, with 11.2% (20/178) suffering early complications. Patients with caustic and button battery ingestion were significantly more likely to experience early complications than those with coin and other foreign body ingestion (p=0.002). Early complications in the caustic and button battery ingestion group made up 85% (17/20) of all early complications and included laryngospasm, prolonged dysphagia, and lower respiratory tract infection. The only late complication in the study population was oesophageal stricture. Further, late complications (8.4%, 15/178) were only noted in the caustic and button battery ingestion group. Conclusions Foreign body and caustic ingestion are a common occurrence in children in our population. Prevention and early management strategies should be prioritised in order to decrease the complications associated with these avoidable injuries.