Title

Determinants and outcome of oesophageal caustic stricture interventions among children at French Medical Institute for Mothers and Children, Kabul, Afghanistan

Date of Award

12-2016

Document Type

Thesis

Degree Name

Diploma in Paediatric Surgery

First Supervisor/Advisor

Mohammad Tariq Rahimi

Second Supervisor/Advisor

Abdul Jalil Wardak

Department

French Medical Institute for Children (FMIC)

Abstract

Background: Caustic Substance Ingestion (CSI) is still one of the significant problems more likely in developing countries, as an incidence of more than 200,000 of caustic exposures has been reported in National Poison Data System at 2008. The incidence of oesophageal caustic stricture is about 10 to 30 % after CSI worldwide.
Aim: This study aimed to find out the demographic characteristics of CSI and its outcome. Moreover, this study will determine the outcome of the oesophageal caustic stricture and its interventional procedures among children at FMIC, Kabul, Afghanistan.
Methodology: Retrospective case series study design was conducted at French Medical Institute for Mothers and Children, Kabul, Afghanistan. Records of patients admitted at surgical department from 2010-2016 with history of caustic substance ingestion reviewed and total of 63 patients based on inclusion and exclusion criteria enrolled in the study. Chi square test, t-test and co-relation was run to find out the associations.
Result: Out of all 63 patients, 36.5% (23 patients) were male and 63.5% (40 patients) were female. The oldest patient was 14 years old and the youngest one was 1-year-old with the mean age of 4.36+ 3.101. About 57.1% were from North West of Afghanistan which the majority of them were from Balkh province. The second highest number of these patients were from Kabul province 25.4%, and 7 % of these patients were from the west of Afghanistan all from Herat and 6.3% were from the south east. CSI in 2 of cases it has been recorded as acid ingestion who was also accompanied with pyloric stenosis and the majority of cases (71.9%) were alkali which is mostly used as whitening liquid (Vitex) for clothes. But families could not describe the type of ingested material in 23.4% of cases so it has been recorded under the name of caustic agent.XV In 15 patients (23%) dilatation was not successful as patients got complicated that 9 was failed, in 6 cases dilatation was done but then in 1 of these patients developed pneumomedistinitis and 5 of them developed pneumothorax during first 24 hours post dilatation which then underwent of gastrostomy or gastrostomy+ oesophagoplasty. After cross tabulation of gender, the P- value of gender and complications stayed 0.006 which is highly significant, showing association, meaning that most of our female patients got complicated. The mean frequency of dilatation of different gender showed P- value = 0.06, which is again highly significant. In related pathologies such as pyloric stenosis and GERD were found significant with gender as all were present in the male children only (P-values <0.005). Moreover, 17 patients have underwent for gastric oesophagoplasty.
Conclusion: Caustic burn, which is fatal accident, is one of the common problems in the Afghanistan even in the urban areas and big cities like Kabul and Balkh. More of the cases are due to alkali ingestion and the incidence is higher in female children. One of the outcomes is oesophageal stricture, the first line treatment is dilatation Savary Gillard dilatators have the highest success rate of 92.5% compared with other surgical procedures, although it is a long term treatment as the recurrence of stricture is more than expected after dilatation.

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