The article by Cello et al in this issue (see p 501) emphasizes two messages: (1) that patients with a history of acid or lye ingestion should undergo early fiberoptic esophagoscopy and gastroscopy because the procedures are safe and delineate the extent of injury; and (2) that many patients may not have injured themselves seriously.
The message about fiberoptic bronchoscopy is valid and timely, because patients without esophageal or gastric burns will be spared costly hospitalizations. Limitations to esophagoscopy exist, in that the extent and severity of the burn may be difficult to assess and, because the esophagoscope is passed to the first severely burned area, but not beyond, distal involvement remains unknown. Regardless, the examination should be performed.
It is the second message, that many patients with a history of liquid caustic ingestion may not have injured themselves seriously, that prompts raising a flag of caution.
The authors' clinical
Liquid Caustic IngestionA Flag of Caution. Arch Intern Med. 1980;140(4):471. doi:10.1001/archinte.1980.00330160031020