1. Case Discussion/Conclusions
Severe Esophageal Stricture in a Child after Ingestion of a Callus Remover Product
Jennifer Plumb, MD, MPH1, Stephen J Fenton, MD2, Richard Thomas, PharmD, DABAT3,
Robert G Bolte, MD1, E Martin Caravati, MD, MPH4
1University of Utah, Division of Pediatric Emergency Medicine, 2University of Utah, Division of Pediatric Surgery,
3Primary Children’s Hospital, Intermountain Healthcare, 4University of Utah, Division of Emergency Medicine
Case Discussion/Conclusions
Case Report
Potassium hydroxide (KOH) ingestion can cause esophageal injury and potential stricture formation. This case describes a delayed presentation of a severe esophageal stricture after ingestion of a widely available beauty product. 
This child swallowed an unknown quantity of callus remover containing KOH, not in a child-resistant container.
His initial well appearance was deceptive and endoscopy was not performed. Unfortunately, he later presented with severe delayed effects of his exposure.
He subsequently developed an extensive stricture of nearly the entire length of the esophagus. Despite several interventions, he remains dependent on gastrostomy tube feedings, and will continue to require serial dilatations and possibly esophageal replacement.
Commercial callus and wart remover products should be required to have child-resistant closures and list the percentage of KOH and other caustics on their product label
An 11 month-old boy presented to an ED after possible ingestion of a callus remover product (Gena® Callus Off™). He was playing with a small bottle without child-resistant lid. Parents estimated the bottle was in his mouth for 5-10 sec, unknown amount of liquid possibly ingested.
Initial ED Evaluation: Within 1 hour of ingestion
No reported symptoms since exposure
Normal exam, slight white plaque reported at base of the tongue
Product ingredients listed in order are: water, potassium hydroxide, glycerin, propylene glycol, and acrylates.
No ingredient quantities or concentrations on the label or website
PC was consulted
He tolerated an oral challenge and was observed for 1 hour prior to discharge
Return ED Evaluation: 18 days later
Presented to our ED with several days of gagging and vomiting, 24 hours intolerance to liquids
No history of respiratory symptoms, fever, or weight loss
Physical exam and vital signs normal, BMP and CBC normal
Esophagram revealed a severe esophageal stricture extending from the carina to the gastroesophageal junction
Admitted and had gastrostomy tube placement for enteral access
Continued Effects: 10 months from exposure
Undergoing esophageal dilatations every 2 weeks
Course complicated by a gastric and esophageal perforation requiring abdominal exploration, gastric repair, and endoscopic covered esophageal stent placement 
Initially only safely able to dilate to 8mm, most recently to 13.5 mm
Still has dysphagia with some solids but clinically improved
        
18 days after exposure – Esophagram findings of severe stricture
19 days after exposure - Endoscopy images showing mucosal injury and stricture
Dilatation and stent placement images
Endoscopy Images courtesy of Dr. Stephen Fenton