Caustic Esophageal Injury

Caustic damage of the esophagus is a deadly condition that is associated with the ingestion of a corrosive caustic substance (strong acids or alkalis). The situation may be an unfortunate coincidence or a suicide attempt. However, committing suicide by drinking acids or alkalis is a very bad idea as we can read below.


A child may have an unfortunate idea to drink an unknown liquid from colorful bottles with pretty pictures. An adult usually drinks a caustic substance if it is kept in unmarked bottle and so it is mistaken with drinking water. Suicide attempts are also possible, but they are less common than accidents.


The liquid badly injures the oral cavity, pharynx, esophagus and the stomach. Shortly after drinking, there appears a sharp pain in the throat that worsens when swallowing. The aggressive fluid can damage a local blood vessel causing blood vomiting. When the caustic agent is aspirated, it also damages the airways, which is accompanied by shortness of breath and coughing up blood. Rupture of the esophagus is the most serious acute complication that is followed with a life-threatening shock condition.


It is appropriate to determine the approximate type and amount of ingested caustic fluid and the local extent of damage. Upper GI endoscopy is probably the best examination method, but it must be performed very cautiously to prevent the esophageal rupture.


Caustic fluids must be kept out of reach of children. Corrosive substances must be stored in clearly labeled bottles and always far from bottles with drinkable fluids. Any attempted suicide by drinking a corrosive substance is a stupid idea - the death is very painful and an unsuccessful suicide attempt brings terrible lifelong consequences.


First aid only makes sense in a few minutes after drinking the corrosive substance. A suitable first aid is drinking a large quantity of water or milk to dilute the aggressive substance. People who drank the corrosive substance shall not induce vomiting. When vomiting, the caustic content of the stomach gets back into the esophagus and it could be also aspirated.

Complex medical treatment is necessary including administration of strong painkillers and intravenous hydration. It is also advisable to administer antibiotics to prevent local infection. In milder cases we just administer intravenous nutrition and monitor the patient with repeated upper GI endoscopy to observe the progress of healing. However, the healing process can cause scarring of the esophagus with narrowing of the lumen and local adhesions. This situation can be treated by repeated careful dilations of the esophagus by special balloons and other devices. If a rupture of the esophagus occurs (or when its tissue is severely damaged), a difficult and complicated surgical procedure should be performed with removal of the damaged part and it replacement by a part of the intestine. However, the prognosis of patients with such procedure is not very good and their quality of life is significantly decreased.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources