Simultaneous caustic ingestion in siblings with divergent treatment and the consequences of health inequity

Accidental caustic ingestions are uncommon but can lead to serious esophageal injury. Clinicians may lack experience grading mucosal findings, creating circumstances for treatment misalignment because management recommendations depend on severity. Regardless of treatment, access to pediatric gastroenterology is essential for severe injuries but is often limited by geography and can be further impacted by poor social determinants of health (SDOH). This report describes the case of a simultaneous accidental caustic ingestion in two previously healthy siblings with severe esophageal injuries. Amidst divergent care plans derived from their initial grading, their outcomes were complicated by the intersection of complex initial assessment, escalating treatment recommendations based on esophageal injury severity, and poor SDOH impeding follow-up. Grading accuracy can be supported with adjunct computed tomography to assess transmural injury. Assessment of a family's SDOH is key to addressing barriers to follow-up and creating a multidisciplinary approach in collaboration with the medical home.