Skip to Main Content


  • • History of ingestion of caustic liquids or solids

    • Burns of the lips, mouth, tongue, and oropharynx

    • Chest pain and dysphagia




  • • Extent of injury depends on degree of exposure to the agent (concentration, duration, and quantity)

    • Ingestion of strong alkali produces "liquefaction necrosis," which involves dissolution of protein and collagen, saponification of fats, dehydration of tissues, thrombosis of blood vessels, and severe deep penetrating injuries

    • Acids produce a "coagulation necrosis" involving eschar formation, which tends to shield the deeper tissues from injury

    • -Greatest injury is to the stomach, with the esophagus remaining intact in over 80% of cases

    • Liquid caustics usually produce more extensive esophageal injury than solids

    • Oropharyngeal burns are common but do not predict distal esophageal injury

    • Esophageal perforation may occur as late as 14 days after injury


Symptoms and Signs


  • • Inflammatory edema of the lips, mouth, tongue, and oropharynx

    • Pain on attempted swallowing

    • Chest pain

    • Dysphagia

    • Drooling of large amounts of saliva

    • Fever, shock, peritoneal signs with esophageal perforation

    • Tracheobronchitis, coughing, and increased bronchial secretions

    • Stridor and respiratory distress

    • Complete esophageal obstruction due to edema, inflammation, and mucosal sloughing may develop


Laboratory Findings


  • • Systemic acidosis and coagulopathy with severe injury


Imaging Findings


  • Esophagoscopy

    • -Usually within 12 hours of admission after initial resuscitation

      -The scope is inserted far enough to gauge the degree of burn but not beyond the proximal extent of injury

    Chest film: May identify pneumomediastinum, pneumoperitoneum or pleural effusion, indicating perforation

    Laryngoscopy and fiberoptic nasopharyngoscopy: May show edema, hyperemia, and mucosal sloughing

    • Water soluble contrast radiography may be used to detect perforation


  • • Esophageal burns can be classified by endoscopic appearance

    • Grade I: Superficial mucosal injury

    • -Mucosal hyperemia and edema

    • Grade II: Partial thickness injury

    • -Mucosal sloughing



      -Grade IIA, patchy injury; grade IIB, circumferential injury

    • Grade III: Transmural injury with periesophageal and/or perigastric extension

    • -Full thickness necrosis

      -Eschar formation

      -Black or gray ulcers


Rule Out


  • • Respiratory distress or severe pharyngeal injury with airway compromise necessitating intubation or tracheostomy

    • Simultaneous gastric injury


  • • Laryngoscopy

    • Fiberoptic nasopharyngoscopy

    • Chest film

    • Early endoscopy

    • Contrast radiography


When to Admit


  • • All cases

    • Mild exposures without symptoms may be discharged after brief observation


  • • Fluid resuscitation and airway protection




  • • Laparotomy

    • Resection of areas of necrosis

    • Cervical esophagostomy

    • Oversew distal segment

    • Feeding jejunostomy




  • • Perforation

    • Grade III injury

    • Severe grade II injury

    • Shock, peritonitis, worsening symptoms




  • • Grade I injury—observation only

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.