Surgical management of corrosive strictures of stomach.

BACKGROUND: Corrosive injuries of the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's experience in managing patients with corrosive strictures of the stomach. METHODS: Records of 28 patients who underwent definitive surgery for corrosive strictures of the stomach in our institution over a 15-year period were reviewed. RESULTS: The main presenting complaints were vomiting (75%), dysphagia (46%) and significant weight loss (100%). Pre-operative evaluation included barium and endoscopic studies. Most patients had antro-pyloric strictures (n=22); in 6 patients, however, near-total or total gastric involvement was observed. Thirteen (46%) patients had associated strictures of the esophagus; of these, 7 responded to esophageal dilation. Strictures of the stomach were managed with resectional procedures like distal gastrectomy (n=16), subtotal gastrectomy (1) or total gastrectomy (3) and esophagogastrectomy (1) in 21 (75%) patients. The remaining 7 patients underwent bypass procedures like gastrojejunostomy (5), stricturoplasty (1), and colonic bypass of esophagus and stomach (1). Three patients had entero-cutaneous fistulae in the postoperative period. One patient died in hospital of septicemia and malnutrition. CONCLUSIONS: In patients with corrosive strictures of the stomach, surgery, tailored according to the extent of gastric involvement and presence of associated esophageal strictures, gives excellent results.

Corrosive pyloric stenosis--a report of two cases.

Two unusual cases of post corrosive pyloric stenosis in adults are reported. Both the cases were diagnosed clinically and confirmed by barium meal examination. Patients were discharged following anterior gastrojejunostomy. Follow-up examination did not reveal any problem. However, both of them are undergoing regular dilatation for the associated oesophageal stricture.

Pyloric obstruction following the ingestion of corrosive acid.

Pyloric obstruction is a well documented end result of ingestion of corrosive acid. Whereas the oesophageal mucosa is resistant to damage, the pyloric spasm and the resultant pooling of acid in the pre-pyloric region, causes injury to this area. The fibrosis of the gastric wall with motility disturbances, and the diminution of acid and pepsin production from damage to the glandular elements, would weigh against the addition of a vagotomy to the drainage procedure. A case of ingestion of concentrated sulphuric acid and the management of its late sequelae, are discussed.

Estenose antro-pilórica por cáusticos ou corrosivos / Antrum pyloric stenosis caused by caustic or corrosive substances

Säo estudados os aspectos de diagnóstico e tratamento da estenose antro-pilórica provocada por ingestäo de substâncias cáusticas ou corrosivas, em doentes portadores de idêntica lesäo esofágica. No presente trabalho, o autor propöe um roterio para o estabelecimento do diagnóstico das lesöes gástricas em doentes portadores de estenose esofágica por ingestäo de cáusticos ou corrosivos e uma padronizaçäo da atitude terapêutica, que pode ser empregada nos 12 doentes acompanhados. Os principais elementos considerados para a realizaçäo dos diagnósticos foram o estudo radiológico contrastado do estômago e a laparotomia que deve ser executada quando se impöe a realizaçäo de gastrostomia para alimentaçäo do doente e manobras de dilataçäo esofágica. A terapêutica padronizada consistiu em resseçäo gástrica do segmento lesado, geralmente antrectomia, com margens de segurança proximal e distal de 1,0 a 2,0 cm e reconstituiçäo do trânsito digestivo por gastroduodenoanastomose término-terminal orais partialis de Billroth I. Os resultados foram bons, a curto e a longo prazo, tendo sido realizado controle pós-operatório clínico, radiológico e algumas vezes por revisäo cirurgica, quando se impôs a realizaçäo de outras intervençöes, com o fechamento de gastrostomia ou a execuçäo de esofagocoloplastia

Acid ingestion causing pyloric obstruction

A case of gastric outler obstruction following acid ingestion in a 2 1/2 years-old chilod is reported. The characteristic features of this injury are minor injury to the mouth, pharynx and oesophagus, and major injury to the stomach. a small amount of acid can produce considerable damage to the stomach. Therefore all patients require admission to hospital. Early barium meal examination and, if available, flexible endoscopy, will identify the extent of damage so as to avoid early discharge of patients when gastric perforation is likely. Emphasis is placed on the need for public education in the prevention of ingestion of corrosive substance bu children