13Apr 2020

PRISE EN CHARGE DES INGESTIONS CAUSTIQUES: EXPERIENCE DU CHU HASSAN II DE FES MANAGEMENT OF CAUSTIC INGESTION: UNIVERSITYHOSPITAL HASSAN II EXPERIENCE

  • Service Dhepato-Gastroenterologie - CHU- Hassan II- Fes.
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The ingestion of causticproductsconstitutes a frequent and serious emergency, whichinvolves the vital and functionalprognosis. The delaybetween ingestion and patient management is a major prognostic factor. Uppergastrointestinalendoscopyis the diagnostic elementused to determine the prognosis and guide therapeutic management. Patients and Methods: This isaretrospectivestudyinvolving 83 patients over a period of 9 years (2000-2009). All patients underwentuppergastrointestinalendoscopy in the acute phase. Results: Our studyincluded 83 patients. The averageageis 35 yearsold.Wenoted a femalepredominancewithsex ratio (M / F) at 0.8.The ingestion of causticproductwas for the purpose of autolysisin 87% of cases.The mostfrequentlyoccurringcausticwasdominated by hydrochloricacid, foundin 40% of cases.The initial digestive endoscopywasperformed in all patients with an averagedelay of 17 h (6h -7d). Wenotedthatat the esophagus, 23.6% of patients had a stage III lesion. In the stomach, the lesionswere more severe, 27.7% of patients had a stage III lesion. Early control (48h -1 week) wasperformedin 23 patients (27.7%) objectifying in the majority of cases a clearimprovement (In 17 cases). Thirteen patients (15.6%) wereoperated on in the acute phase. the lateendoscopic control (21 days) wascarried out in 14 patients (16.8%) objectifyingstenosis in seven patients, including four in the esophagus. In ourseries, 12 patients died (14.4%) including six aftersurgery. Conclusion: The ingestion of causticproductsis a diagnostic and therapeutic emergency requiringmultidisciplinary PEC. Endoscopyis the key examination to guide management.The risk in the acute phase isrelated to the occurrence of shock or surgical complications thatmayindicate urgent surgery. Causticstrictures come secondary must be as soon as possible for possible PEC.In ourseries 15.6% of patients wereoperated on in the acute phase, causticstenosisoccurredin 8.4% of cases and 14.4% of deaths.


  1. Landru J, Jacob L. Anesthesie-reanimation pour lesions del?sophage apres ingestion dun produit caustique. EMC, 36-726-A-10
  2. Consensus en endoscopie digestive?: prise en charge des ?sophagites Ectaendosc (2011) 41?:303-308.
  3. Kikendall J. Caustic ingestion injuries. Gastroenterol Clin North Am 1991 ; 20 : 847-857
  4. Fieux a,∗, M. Chirica b, A. Villa c, M.-R. Losser a, P. Cattan b,∗∗. Ingestion de produits caustiques chez ladulte. Reanimation (2009) 18, 606?616.
  5. De Ferron P, Gossot D, Azoulay D, Sarfati E, Celerier M. Esophagogastricinjuriesbyliquidchlorinebleachinadults. DigSurg 1988 ; 5 : 148-150
  6. De FerronP,GossotD,SarfatiE,CelerierM. Les lesions ?sogastriques par ingestion deau de javel chez ladulte. Presse Med 1987 ; 16 : 2110-2112
  7. Gossot D, Tagny G, Sarfati E, Celerier M. Les lesions provoquees par lingestion dammoniaque. Gastroenterol Clin Biol 1990 ; 14 : 191-192
  8. Zargar SA, Kochhar R, Nagi B, Mehta S, Mehta SK. Ingestion of corrosive acids. Spectrum of injury to uppergastrointestinal tract and naturalhistory. Gastroenterology 1989 ; 97 : 702-707.
  9. ABIDINE LKBIR . BRULURES CAUSTIQUES DU TRACTUS DIGESTIF, these de doctorat en medecine. Faculte de medecine et de pharmacie de Marrakech. These N? 054.2018
  10. Yung-Hung Chang.Chi-HsunHsieh.Chien-Hung Liao The SurgicalStrategy in Massive Corrosive Injury in Digestive Tract: Is the Extensive SurgeryAppropriate? World J Surg . Societe Internationale de Chirurgie 2018.
  11. GHYZLAINE J.. Intoxications par les produits caustiques et irritants. Donnees du centre antipoison du Maroc (1980-2011). Toxicologie Maroc,2013, 18:16.
  12. FAGNIEZ, D. HOUSSIN. Lesions caustiques du tractus digestif superieur. Pathologie chirurgicale. 1991; 117-123
  13. CHRISTESEN HBT. Caustic ingestion in adults-epidemiology and prevention.JToxicol-Clin Toxicol 1994;32:557- 568.
  14. RIGO, L. CAMELLINI, F. AZZOLINI, S. GUAZZETTI, G. BEDOGNI, A. MERIGHI, L. BELLIS, A. SCARCELLI, F. MANENTI. Whatis the utility of selectedclinical and endoscopicparameters in predicting the riskofdeathaftercaustic ingestion? Endoscopy. 2002 Apr; 34 [4]:304-10.
  15. POLEY, E. STEYERBERG, E. KUIPERS, J. DEES, R. HARTMANS, H. TILANUS, P.SIERSEMA. Ingestion of acid and alkaline agents: outcome and prognostic value of earlyupperendoscopy. Gastro-intestinal Endoscopy, Volume 60, Issue 3, Pages 372-377.2004.
  16. MAMEDE RC, DE MELLO FILHO FV. Treatment of caustic ingestion: an analysis of 239 cases. Diseases of the Esophagus, 2002, 15 (3) :210-3.
  17. CELERIER.Les lesions caustiques de l?sophage chez ladulte.AnnChir 2001 126 : 945 : 949
  18. CELERIER M, GAYET B. Les br?lures par ingestion de caustique. In: Celerier M, Gayet B, editors. Les traumatismesde l?sophage. Paris:Arnette-Blackwell; 1995. p.9?64.
  19. DI CONSTANZO J., NOIRCLERC M., JOUGLARD J. ET AL. New therapeuticapproach to corrosive burns of the uppergastrointestinal tract. Gut, 1980 ; 21 : 370-5.
  20. ACR NUNES, JM. ROMAOZINHO, JM. PONTES, V. RODRIGUES, M. FERREIRA, D. GOMES, D.FREITAS. Riskfactors for stricturedevelopmentaftercausticingestion.Hepato-Gastroenterology 2002; 49: 1563-1566.
  21. RODRIGUEZ, JL. MEZA FLORES. Clinical-epidemiologicalcharacteristics in caustics ingestion patients in the Hip?litoUnanue National Hospital. RevGastroenterologyPeru. 2003 Apr-Jun; 23 [2]: 115-25.
  22. R Lesions du tractus digestif superieur par ingestion dagents caustiques. Etude dune serie de 68 cas. Thesemed. NANCY 2006 n ?12.
  23. ZARGAR S.A., KOCHHAR R., MEHTA S. ET AL. The role of fiberopticendoscopy in the management of corrosive ingestion Andmodifiedendoscopic classification of burns. Gastro-intest.Endosc. 1991;n? 37: 165-9.
  24. RIBET M., LUGEZ B. ET GOSSELIN B. : Lesions gastro- intestinales secondaires ? lingestion de caustiqueproblemesdurgence, Chirurgie [Paris], 1978, 104, n?7, p: 656-66.
  25. EL MOUSSAOUI A. Lesions caustiques du tube digestif superieur, These de medecine ?rabat-1985, n?/220.
  26. M, CHAUVIN. G, JOUGLARD.J, GARBE.OIRCLERC. L, ET DICOSTANZO.J. Les brulures du tractus digestif superieur. EMC., Paris, estomac-intestin, 4-1978,9200 a- 10,p :1-14
  27. M, DICOSTANZO.J, SASTRE.B, DURIF.L, FULACHIER.V, BOTTA.D, BRUN.J, AND DRIF.B Reconstructive operation for esophago-gastric corrosive lesions. USA, 87, pp: 291-294, 1984.
  28. LECLERC, KASWIN.R, CELERIER.M, DUBOST.C, Brulures caustiques ?so-gastriques de ladulte, etude anatomo-pathologique. Ann.oto-laryng.Paris, 95, n?6, p : 389-393,1978
  29. GORNET. Prise en charge diagnostique et therapeutique des br?lures digestives par caustique. Les journees EPU Paris VII. Journee de gastroenterologie Paris, 7janvier 2005.
  30. EL HAMOUMIM. Les br?lures caustiques du tractus digestif superieur (? propos de 58 cas) . These doctorat medecine, Rabat, 2016, n? 60, 191 pages.
  31. R, SILVESTINI.M, MARINO.F Airwayendoscopicsurgery, department of pathology, Paduauniversity hospital.2003.
  32. Rapport de la reunion de Consens sur les lesions caustiques du tube digestif. Societe Algerienne danesthesie, reanimation de soins intensifs et durgence. Alger, El Aurassi 1999.
  33. ANDRIEU-GUITRANCOURT J, COULY G. Anatomie du pharynx, Encycl. Med Chir-Paris-O.R.L.20845 A10.
  34. Gault V, Cabral C, Duclos J, Resche-Rigon M, De Bazelaire C, Loiseaux F, et al. Inter?t de la tomodensitometrie dans la prise en charge des br?lures caustiques severes de l?sophage (abstract). J Chir 2009;145:9
  35. Sarfati E, Gossot D, Assens P, Celerier M (1987) Management ofcaustic ingestion in adults.Br J Surg 74:146?148
  36. M, DICOSTANZO.J, SASTRE.B, DURIF.L, FULACHIER.V, BOTTA.D, BRUN.J, AND DRIF.B Reconstructive operation for esophago-gastric corrosive lesions. USA, 87, pp: 291-294, 1984.
  37. A, DAOUES.A, BEN YOUNES.M ET FOURATI.M Les ?sophagites caustiques : considerations diagnostiques et therapeutiques .A propos de 16 cas. La Tunisie Medicale, vol.63, n?11, p: 601-608,1985
  38. J, PEYNEGRE, BESSON-LEAUD.M et CLOUP.M Les intoxications par caustique chez lenfant Sem.hop.Paris, 55, n?17-18, p : 883- 889,1979
  39. RABARY, JADAT, H.FALKMAN AND B.EURIN, Reanimation et anesthesie des maladies atteintes de brulures caustiques du Tube digestif au cours des premiers jours., Reanimation et medecine durgence, Editor, expansion scientifique fran?aise, Paris-1987, pp.373-388
  40. FOURQUIER P. Prise en charge chirurgicale des br?lures caustiques de l'axe aero-digestif superieur chez l'adulte ; ? propos d'une serie de 935 patients [These]. Paris, France : Universite Paris 6, 1993, 73 p.
  41. A ET DUBREUIL Les ?sophagites corrosives e.m.c. paris, oto-rhino-laryng., 20820.a10.1984, p : 1-10
  42. J, HOUCKE.PH, LISAMBERT.B, DESURMONT.PH, CANTINEAU.A, ET DESSEAUX.G Brulures digestives hautes par substances corrosives, reflexions a propos de 25 observations. Med.Chir.Dig.10, p: 97-101.1981.
  43. J, HOUCKE.PH, LISAMBERT.B, DESURMONT.PH, CANTINEAU.A, ET DESSEAUX.G Brulures digestives hautes par substances corrosives, reflexions a propos de 25 observations. Med.Chir.Dig.10, p: 97-101.1981.
  44. Gossot D, Sarfati E, Celerier M. Anastomose ?so-jejunale immediate apres gastrectomie totale pour necrose caustique. Ann Chir 1989;43:352?5.
  45. E, LAVAUD.J, PEYNEGRE.R, RECEVEUR.M ET HADDAD.J Bilan des brulures ?sophagiennes par caustiques chez lenfant Ann. Oto-rhinolaryng.paris.1979.69, n?3, p: 133-140
  46. CHAKOR K., DAOUDI A. Atelier de dissection de labdomen., Annee universitaire 2006-2007
  47. Rouviere H. Anatomie humaine descriptive, topographique et fonctionnelle. Lestomac. 11eme editionMasson. 1981.
  48. BRETTE M., AIDAN K., HALIMI B. ET AL. Pharyngo-esophagoplasty by right coloplasty for thetreatment of post-causticpharyngo-laryngealesophagealburns: a report of 13cases. Ann. Oto-laryngol.Chir. Cervico-fac. 2000; 117 p: 147-54.

[M. Bedou, N. Lahmidani, M. Figuigui, M. Lahlali, A. Lamine, H. Abid, M. Elyousfi, D. Benajah, M. El Abkari and A. Ibrahimi (2020); PRISE EN CHARGE DES INGESTIONS CAUSTIQUES: EXPERIENCE DU CHU HASSAN II DE FES MANAGEMENT OF CAUSTIC INGESTION: UNIVERSITYHOSPITAL HASSAN II EXPERIENCE Int. J. of Adv. Res. 8 (Apr). 205-214] (ISSN 2320-5407). www.journalijar.com


DR BEDOU
Service d’hépato-Gastroentérologie – CHU- Hassan II- Fès (Maroc)

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