First, the overview of esophageal chemical corrosion injuries are mostly seen in young children under 5 years of age, generally due to the accidental ingestion of strong acid, strong alkali substances. In recent years, esophageal chemical corrosion injuries have been reduced. The occurrence of areas in the north is more than in the south, and the incidence is relatively high in rural areas in northern and central China. In addition, the accidental administration of lysol, iodine, potassium permanganate, etc. is also more common in the clinic. Etiology 1. Chemical burns in the esophagus caused by accidentally taking strong acid, strong alkali or other corrosive drugs. 2. Scalding the esophagus by accidentally drinking freshly boiled water. Clinical manifestations 1.Acute stage Immediately after the injury, there is burning pain in the lips, tongue, mouth, throat and esophagus, and young children often show irritability, crying and restlessness, salivation, difficulty in swallowing and refusal to eat. 1 to 2 hours later, mucosal edema occurs, and reaches a peak in 6 hours, at which time the edema is serious, and if the edema involves the larynx, there can be hoarseness and inspiratory respiratory difficulty, and serious cases can die of suffocation due to laryngeal obstruction. (1) First-degree burns In addition to the above symptoms, poisoning manifestations and swallowing difficulties are obvious, and children have different degrees of dehydration and electrolyte disorders. It may be manifested as local edema. (2) Second-degree burns can show serious symptoms of poisoning, such as high fever and shock. If esophageal perforation occurs, the child often complains of chest pain and breath-holding, and if the large blood vessels in the chest cavity are injured, sudden hemoptysis and vomiting of blood may occur, and death may occur immediately. 2.Sub-acute phase, also known as the inflammation dissipation phase, is in the second to third week after the burn. During this period, the acute inflammation decreases, the edema and congestion of the esophagus subsides, the dysphagia improves, and the general condition of the child also improves. 3.The scar stenosis period The child will vomit or drip after eating, and salivation, dehydration, acidosis and malnutrition are common. The lips, oral mucosa, tongue and pharynx form ulcers and white membranes, with pain and difficulty in swallowing, salivation, vomiting, and inability to eat and drink. When strong alkali injures the vocal cords and large airways, respiratory distress and coughing may occur. Dehydration, acidosis and combined lung infections may also occur. Moderate and severe burns can immediately develop toxic shock, and also coughing due to concurrent reflux aspiration, bronchitis and pneumonia can occur. Corrosive esophagitis is generally not difficult to diagnose based on its history, symptoms and signs. 1.Blood test In combination with bleeding esophageal perforation and respiratory tract infection, the blood leukocyte count is elevated and hemoglobin is decreased. X-ray examination is not significant in the early stage, but after 3 weeks, barium meal examination of esophagus can help to diagnose the disease, which can generally detect the formation of esophageal stricture and observe the site of esophageal burn and its severity. X-ray examination should be done only after the acute inflammation subsides and the patient can swallow liquid food. If esophageal fistula or perforation is suspected, the contrast agent may flow into the respiratory tract and iodine oil imaging is preferable. (1) Mild The early stage is secondary spasm of the lower esophagus, the mucosal texture is still normal, but it may be mildly thickened and distorted, and later scarring and stenosis are not obvious. (2) Moderate The length of esophageal involvement increases, secondary spasm is significant, and the mucosal texture is irregular and jagged or beaded. (3) Severe The lumen of the tube is obviously narrowed, even in the shape of a rat tail. 3.Esophagoscopy Although esophagoscopy can directly visualize the burned condition, it is not recommended in the early stage (within 1 week) because of the risk of causing esophageal perforation. In the late stage, the beginning of the stricture can be observed. In general, it is difficult to pass through the entrance of the stricture, so esophagoscopy is not recommended for multiple or total esophageal strictures. Because the incidence of cancer is higher than that of normal esophagus, especially in esophageal strictures caused by strong alkali, some children need regular review of endoscopy to dilate the strictures and to detect esophageal cancer at an early stage. The first aid measures in the acute stage are to rescue toxic shock, correct water and electrolyte disorders, maintain nutrition, reduce pain and avoid the formation of esophageal scar stenosis. Immediately after the burn, contact with the poison should be terminated, eliminate the poison not yet absorbed by the gastrointestinal tract, and promote the discharge of absorbed poison and identify its nature. According to the nature of the poison, choose to apply the corresponding antidote: (1) strong acid poisoning can be neutralized by weak alkali or magnesium milk, soap and water, aluminum hydroxide gel, etc. (2) Strong alkali poisoning can be neutralized by weak acids, such as dilute vinegar and fruit juice. After neutralization, egg white and cow’s milk can be given to protect the trauma. 2.Prevent infection Prednisone (prednisone) once every 8 hours, a course of treatment for 4 to 5 days, and then gradually reduce the amount, and delayed to a few weeks, before the drug can be stopped. Use broad-spectrum antibiotics as appropriate according to the presence or absence of infection, the degree of infection and the type of bacteria. 3.Prevent luminal stenosis Dilation by mercury probe as early as possible, as early as 24 to 48 hours after the burn, usually 4 to 6 weeks for dilation. 4.Surgical treatment If dilatation is ineffective, esophagectomy and esophagogastric anastomosis are required, or colon instead of esophagus to restore the continuity of the digestive tract. Circulatory dilation of the esophagus, also known as retrograde dilation, is indicated for stenosis in any part of the esophagus and for full-length esophageal stenosis. After the gastrostomy, the child is asked to swallow slowly a thread the length of which is equivalent to the distance from the root of the ear through the anterior nostril to about 5 cm below the glabella. Then, water was injected into the stomach through the gastrostomy site, and then water was sucked through the gastrostomy opening with a suction device, and the swallowed wire was sucked out of the gastrostomy opening, and the end of the wire left in the mouth was connected to the end of the wire sucked out of the gastrostomy with a non-toxic rubber dilation probe, which was circulated from the mouth to the stomach or from the gastrostomy to the mouth once a week. The probes were gradually increased in thickness until the child’s feeding condition improved, and then the probes were dilated once every 2 weeks or once a month. After the esophageal stricture disappears and feeding is normal, gastric fistula repair can be performed. Prognosis Children with mild corrosive esophageal injury can have no complications. In children with severe burns, acute complications such as esophageal perforation, hemorrhage, tracheoesophageal fistula, etc. are likely to occur, and the morbidity and mortality rate is high. 70% of children with IIb or III degree esophageal burns have strictures, and the risk of esophageal squamous epithelial carcinoma increases significantly in children with esophageal strictures after corrosive esophageal injury. Prevention 1. Strict management to prevent esophageal injury caused by accidental ingestion of strong acids and bases. 2. Strengthen education to prevent children from taking corrosive substances. 3. Prevent infection and pay attention to wound cleanliness and hygiene.