Po662 Life After A Caustic Impact.

Joana Carvalho1, Susete Simões1, Estela Rita Loureiro2, David Brito3 e Lígia Martins1
1USF Buarcos; 2UCSP Mealhada; 3USF Mondego
Context: Caustic ingestion can cause severe injury. Only 20% occur in adults, mostly in suicidal subjects. Though, the accidents remain an important cause. The degree and extent of damage depends on several factors. Upper GI Endoscopy (UGIE) should be performed during the first 24 hours, however is contraindicated if there is haemodynamic instability or evidence of perforation. Long-term complications include oesophageal strictures (2-3 weeks later) and oesophageal carcinoma (10- 25 years later). In a holistic approach, Family Physicians (FP) develop an important role through the early referral and follow up of these patients.
Case description: A 54 year old Caucasian man belonging to a blended family (2 elements in consensual union) with hypertension, and hypercholesterolaemia went to the FP one week after ingestion of a caustic, in the workplace. He presented complaints of epigastric pain and was medicated already in ER, at the time of the accident. After contact with gastroenterologist for joint orientation, he did UGIE two weeks later, which revealed impassable oesophageal stricture (Discussion: This case is of special relevance not only due to the acute disease, but also by the need to follow up the risk of malignancy. It raises several issues that should be a part of the daily concerns of a FP, including the employment conditions of their patients, the importance of a close interaction between primary and secondary care, and even the monitoring of changes that increase household vulnerability and, for its violence and speed of installation, requires new roles and new balances.
Caustic ingestion, oesophageal stricture, family dynamics