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J Korean Soc Emerg Med > Volume 20(3); 2009 > Article
Journal of The Korean Society of Emergency Medicine 2009;20(3): 297-303.
Computed Tomography Grading for Predicting Esophageal Stricture in Caustic Injury
Jun Hwan Uhm, Young Hun Park, Hyun Ho Ryu, Byung Kook Lee, Kyung Woon Jeung, Tag Heo, Yong Il Min
Department of Emergency Medicine, College of Medicine, Chonnam National University, Korea. oriryu@hanmail.net
The aim of this study was to investigate the ability of thoracic computed tomography (CT) to predict esophageal stricture formation and risk factors associated with the development of stricture induced by ingestion of caustic materials.
This was a study of 41 patients who had visited an emergency care center following ingestion of caustic substances sometime between January 1998 and August 2008. A retrospective analysis of medical records was performed. Findings for the esophageal lesion were classified according to changes in the esophageal wall and the infiltration of peri-esophageal soft tissue. Also, clinical, laboratory, and endoscopic data from these patients were reviewed. The correlation between the degree of esophageal damage seen on CT scans and esophageal constriction seen on esophagography were then evaluated.
A total of 41 cases of caustic ingestion were identified (age range, 20~82 years). The most common caustic agent ingested was acid (70%). The most frequent cause for ingestion was attempted suicide (70%); the other cases (30%) were accidental ingestion. The findings on thoracic CT in the 41 patients were as follows: first-degree esophageal injury in 4 (9.8%), second-degree in 8 (19.5%), third-degree in 17 (41.6%), fourth-degree in 12 (29.3%). Fourteen patients (34.1%) developed caustic esophageal stricture. The closer the degree of esophageal damage was to grade IV, the more prevalent the esophageal constriction became. This correlation was statistically significant (p<0.001). Of the 41 patients, 26 underwent endoscopy at an early stage after they visited an emergency care center. An analysis of the correlation between the degree of esophageal damage seen on endoscopy and that seen on CT scans was performed. This revealed a significant correlation (p=0.002, r=0.585).
Thoracic CT grading suggesting periesophageal soft tissue infiltration and fluid collection (grade III to IV) rather than only edema (grade I) may be associated with stricture formation. Early CT grading is safe and useful for predicting the development of stricture induced by caustic ingestion.
Key words: Spiral computed tomogrophy, Thorax, Esophageal stenosis, Caustics, Injuries
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