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Lesões cáusticas do trato digestivo superior : caracterização de uma série e revisão da literatura
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Abstract(s)
A ingestão de produtos cáusticos é um evento raro, mas potencialmente fatal, que pode causar graves sequelas a curto e/ou a longo prazo. A abordagem destas lesões e das suas sequelas é bastante complexa, sendo crucial a colaboração de uma equipa multidisciplinar. O objetivo deste trabalho é realizar uma revisão acerca do estado da arte e analisar a realidade do HSM-CHLN. Desta forma, foram avaliados retrospetivamente os dados de 62 doentes com história de ingestão cáustica seguidos no HSM-CHLN entre 2013 e 2019. A maioria dos doentes ingeriu a substância corrosiva na idade adulta (90%). A patologia psiquiátrica e/ou perturbação de abuso de álcool estava presente em 29 (47%) doentes. A patologia psiquiátrica mais prevalente foi o síndrome depressivo. A maior parte das ingestões decorreram de forma intencional (60%). Os produtos alcalinos foram ingeridos por 38 (61%) doentes. As lesões esofágicas de grau 2a e gástricas de grau 0 foram as mais frequentes. No que diz respeito ao desenvolvimento de estenoses, 19 (31%) doentes apresentaram esta sequela, 15 esofágicas e 4 gástricas. A intervenção cirúrgica foi realizada em 14 doentes. A ingestão acidental de cáusticos pela população pediátrica continua a ser um grave problema de saúde pública apesar das medidas implementadas para a sua prevenção nos últimos anos, pelo que deverá existir um reforço na prevenção. Já na população adulta, a patologia psiquiátrica é o principal motivo de ingestão cáustica neste grupo, sendo crucial um maior investimento na prevenção, diagnóstico precoce e seguimento destes doentes. Apurou-se que a abordagem inicial destes doentes no serviço de urgência foi bastante variável, pelo que seria benéfico padronizar a mesma, de forma a melhorar os cuidados prestados.
Caustic ingestion is a rare but potentially fatal event, which can cause both short and/or long-term severe sequelae. The management of these injuries and their sequelae is very complex and requires a multidisciplinary approach. The aim of this work is to review the state-of-the-art of this topic and to analyze the reality of our tertiary center (HSM-CHLN). We retrospectively evaluated the data of 62 patients with a history of caustic ingestion who were followed at HSM-CHLN between 2013 and 2019. Most patients ingested the corrosive substances in adulthood (90%). Psychiatric pathology and/or alcohol abuse disorder was present in 29 (47%) patients, being depressive syndrome the most significant pathology. Most intakes occurred intentionally (60%). The alkaline products were ingested by 38 (61%) patients. Grade 2a and grade 0 esophageal and gastric lesions were the most frequent, respectively. Regarding the development of strictures, 19 (31%) patients presented this sequel, 15 esophageal and 4 gastric. Surgical intervention was performed in 14 patients. The accidental ingestion of caustics by children continues to be a serious public health issue, despite the measures implemented to prevent it in recent years. For that reason, an obvious outcome is that prevention must be reinforced. Psychiatric pathology is the main reason for caustic ingestion in adults, therefore greater investment in prevention, early diagnosis and follow-up of these patients is needed. In this study it was verified that the initial approach to these patients by the emergency department was quite heterogeneous. Therefore, patient management must be standardized, which will ultimately improve the quality of the provided care.
Caustic ingestion is a rare but potentially fatal event, which can cause both short and/or long-term severe sequelae. The management of these injuries and their sequelae is very complex and requires a multidisciplinary approach. The aim of this work is to review the state-of-the-art of this topic and to analyze the reality of our tertiary center (HSM-CHLN). We retrospectively evaluated the data of 62 patients with a history of caustic ingestion who were followed at HSM-CHLN between 2013 and 2019. Most patients ingested the corrosive substances in adulthood (90%). Psychiatric pathology and/or alcohol abuse disorder was present in 29 (47%) patients, being depressive syndrome the most significant pathology. Most intakes occurred intentionally (60%). The alkaline products were ingested by 38 (61%) patients. Grade 2a and grade 0 esophageal and gastric lesions were the most frequent, respectively. Regarding the development of strictures, 19 (31%) patients presented this sequel, 15 esophageal and 4 gastric. Surgical intervention was performed in 14 patients. The accidental ingestion of caustics by children continues to be a serious public health issue, despite the measures implemented to prevent it in recent years. For that reason, an obvious outcome is that prevention must be reinforced. Psychiatric pathology is the main reason for caustic ingestion in adults, therefore greater investment in prevention, early diagnosis and follow-up of these patients is needed. In this study it was verified that the initial approach to these patients by the emergency department was quite heterogeneous. Therefore, patient management must be standardized, which will ultimately improve the quality of the provided care.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Keywords
Ingestão cáustica Lesão cáustica Estenose Ácido Alcalino