Clinical Features

Patients who present after caustic ingestion may have severe pain, odynophagia, dysphonia, oral/facial burns, respiratory distress, and/or abdominal pain, and be drooling, coughing, or vomiting. Dysphonia, stridor, and respiratory distress may indicate laryngotracheal injury, whereas dysphagia, odynophagia, epigastric pain, and vomiting may indicate esophageal and gastrointestinal (GI) injury.

Conflicting data exist on the reliability of presenting signs and symptoms to predict upper GI injuries. An early retrospective study of caustic ingestions by Gaudreault and colleagues5 reported 12 percent of patients who presented without initial signs or symptoms of upper GI injury were subsequently found to have serious esophageal injuries of grade 2 or higher (Table 17.5.-3). A subsequent prospective study by Gorman and coworkers found that no single symptom, or group of symptoms, had 100 percent positive or negative predictive value for esophageal injury. 6 All patients with serious esophageal injuries (grade 2 or 3) in the study by Gorman and colleagues5 had some initial sign or symptom (drooling, abdominal pain, etc.).

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