A 3-year-old boy is rushed to the emergency room in acute distress. The child has vague chest pain and difficulty swallowing. He refuses to drink water. Physical examination shows drooling and salivation. Vital signs are normal. The mother states that she saw the boy ingesting a liquid used to clear drains. If this chemical was a strong acid, which of the following histopathologic findings would be expected in the esophagus of this child?

Chemical injury to the esophagus usually reflects accidental poisoning in children, attempted suicide in adults, or contact with medication. Ingestion of strong acids produces an immediate coagulative necrosis in the esophagus, which results in a protective eschar that limits injury and further chemical penetration. By contrast, ingestion of strong alkaline solutions is accompanied by liquefactive necrosis (choice E), with inflammation and saponification of membrane lipids. Alkaline solutions are particularly insidious because they are generally odorless and tasteless and, therefore, easily swallowed before protective reflexes come into play.Diagnosis: Chemical esophagitis