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Toxicological information

Direct observations: clinical cases, poisoning incidents and other

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Administrative data

Endpoint:
direct observations: clinical cases, poisoning incidents and other
Type of information:
other: case report
Adequacy of study:
supporting study
Reliability:
3 (not reliable)
Rationale for reliability incl. deficiencies:
other: Clinical observation of a 42-year-old depressed female who swallowed 30 ml of a 16% sodium hydroxide solution.

Data source

Reference
Reference Type:
publication
Title:
Gastric Antral Patch Esophagoplasty for Extensive Corrosive Stricture of the Esophagus
Author:
Hugh et al.
Year:
1991
Bibliographic source:
World J Surg 15, 299-303

Materials and methods

Study type:
other: suicidal ingestion
Endpoint addressed:
not applicable
Principles of method if other than guideline:
A case is reported of a patient with a 9-cm stricture of the esophagus caused by ingestion of sodium hydroxide, who was treated by gastric antral patch esophagoplasty.
GLP compliance:
no

Test material

Constituent 1
Chemical structure
Reference substance name:
Sodium hydroxide
EC Number:
215-185-5
EC Name:
Sodium hydroxide
Cas Number:
1310-73-2
Molecular formula:
HNaO
IUPAC Name:
sodium hydroxide
Details on test material:
- Name of test material (as cited in study report): "Drano", sodium hydroxide solution
- Physical state: sodium hydroxide solution

Method

Type of population:
other: one case, 42-year-old female
Subjects:
- Number of subjects exposed: 1
- Sex: female
- Age: 42 year
- Known diseases: depression
- Other: She was 12-16 weeks pregnant at the time, and had previously been in good health and free of any digestive symptoms
Ethical approval:
not applicable
Route of exposure:
oral
Reason of exposure:
intentional
Exposure assessment:
not specified
Details on exposure:
A 42-year-old depressed female swallowed approximately 30 ml of "Drano", a 16% sodium hydroxide solution, in a suicide attempt.
Examinations:
- Other: a number of endoscopic examinations; barium X-ray studies
Medical treatment:
Dilatations of the esophagus, and a feeding jejunostomy was established. A termination of pregnancy and tubal ligation was carried out. Further dilatations were performed, some of which were abandoned, and during one of which an apparent perforation of the esophagus occurred. This complication was treated conservatively, although a laparotomy was done because of suspected peritonitis. Although it was knon from the previous laparotomy findings that there was considerable scarring in the stomach, the patient's condition was considered to be suitable for a gastric antral patch esophagoplasty (GAPE) provided sufficient supple gastric wall could be obtained.

Results and discussion

Results of examinations:
- Other: Barium X-ray studies showed a stricture 9 cm in length in the body of the esophagus, commencing above the level of the tracheal bifurcation, and extending to just above the diaphragm. At endoscopy, a pharyngeal web was noted at the level of the epiglottis, the latter structure apperently having been complety destroyed. A standard-sized endoscope could just be passed alongside a small endotracheal tube. There was slight stenosis at the level of the cricopharyngeal sphincter, and a very tight esophageal stricutre was encountered at 22 cm from the incisor teeth; no identifiable lumen was present at this level.
Effectivity of medical treatment:
After leaving the hospital (gastric antral patch esophagoplasty for extensive corrosive stricture of the esophagus), the patient noted occasional sticking of solid food in the pharyngeal region, and endoscopy 8 weeks post-operatively showed some stenosis at the level of the cricopharyngeus muscle, where a slight stricture had previously been encountered. This was dilated readily, and the remainder of the esophageal lumen was found to be normal in caliber. A further endoscopy 6 months postoperatively showed the esophagus to have a normal sized lumen. The lining of the patch had the appearance of healthy gastric mucosa. the patient had continued to eat normally, without the need for futher dilatations during a follow-up period of 15 months. Serum gastrin levels have remained normal, indicating that the patch is nog producing excessive amounts of this hormone. Manometric and esophageal pH monitoring studies were done 8 weeks after operation. Manometry was performed with a dent sleeve attached to low compliance capillary perfusion apparatus. Postoperative 24 hour pH monitoring was carried out using an antimony probe connected to a Synectics "Digitrapper", the probe tip being placed 5 cm proximal to the manometrically idntified high-pressure zone. There were very few reflux episodes, and such episodes were entirely absent during sleep.

Applicant's summary and conclusion