After ingestion of a corrosive chemical or mixture, endoscopy should be performed to determine the severity of the injury. One method of grading the severity of injury is modeled after the classification of thermal burns to the skin.
The endoscopic evaluation should be done to include both the entire esophagus and stomach, since burns can be multifocal with different severities.
Pathologic stages:
(1) First degree burn: superficial involvement of the mucosa.
(2) Second degree: transmucosal involvement with or without involvement of the muscularis. No extension into periesophageal or perigastric tissue.
(3) Third degree: full thickness injury with extension into the periesophageal or perigastric tissue. Adjacent organs (intestine, pancreas, liver, spleen, mediastinal structures) may be involved.
Finding
First Degree
Second Degree
Third Degree
bleeding
hyperemia without bleeding
mild to moderate bleeding
moderate to severe bleeding
edema
mild
moderate
severe
mucosal loss
may involve the superficial layers of the mucosa
mucosal ulceration, blistering
deep ulcerations with possible perforation
exudate
none
present with pseudomembrane
present with pseudomembrane
appearance if endoscopy delayed
none
granulation tissue
eschar formation
To read more or access our algorithms and calculators, please log in or register.
