Abstract
Corrosive injury is common amongst young adults attempting suicide. Apart from oesophageal burns, many have predominant gastric injuries. Resulting gastric strictures need surgery in majority. Common practice is to do feeding jejunostomy followed by definitive surgery after a few months. But it is challenging in poor patients to maintain tube feeding. In view of this, we looked into alternative safe early definitive approach. This study was done in the Department of Surgical Gastroenterology in Medical College Kolkata. Over the last 8 years (January 2009 to April 2017), consecutive 74 patients with corrosive gastric strictures were included. Extent of gastric cicatrisation was assessed by endoscopy and barium study. Nutrition was maintained by oral, naso-jejunal or feeding jejunostomy. Early definitive surgery was preferred. Patients’ follow-up was evaluated. Patients presented with vomiting, weight loss and dysphagia. Out of 74 patients, 30 had associated oesophageal strictures which were amenable to dilatation. Pre-pyloric short strictures were found in 52 (70.27%) patients. Surgical procedures included stricturoplasty for short strictures (70%) and gastrojejunostomy for more severe gastric cicatrisation. Seventy-five per cent of the patients had definitive surgery within 3 months of injury. Complications included mortality in 3 (4.05%) patients and wound dehiscence, pneumonitis and ileus. All patients gained weight within 6 to 8 weeks and doing well during follow-up. Management of corrosive gastric injury depends on the extent of gastric involvement, associated oesophageal strictures and general condition of the patient. In majority, early definitive surgery like stricturoplasty, avoiding gastric resection or bypass provides very satisfactory and physiological outcomes.
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References
Ananthakrishnan N, Parthasarathy G, Kate V (2010) Chronic corrosive injuries of the stomach—a single unit experience of 109 patients over thirty years. World J Surg 34:758–764. https://doi.org/10.1007/s00268-010-0393-8
Ramasamy K, Gumaste VV (2003) Corrosive ingestion in adults. J Clin Gastroenterol 37:119–124. https://doi.org/10.1097/00004836-200308000-00005
Kochhar R, Sethy PK, Nagi B, Wig JD (2004) Endoscopic balloon dilatation of benign gastric outlet obstruction. J Gastroenterol Hepatol 19:418–422. https://doi.org/10.1111/j.1440-1746.2003.03283.x
Gupta V, Wig JD, Kochhar R, Sinha SK, Nagi B, Doley RP, Gupta R, Yadav TD (2009) Surgical management of gastric cicatrisation resulting from corrosive ingestion. International J Surg 7:257–261. https://doi.org/10.1016/j.ijsu.2009.04.009
Chaudhary A, Puri AS, Dhar P, Reddy P, Sachdev A, Lahoti D, Kumar N, Broor SL (1996) Elective surgery for corrosive-induced gastric injury. World J Surg 20:703–706. https://doi.org/10.1007/s002689900107
Agarwal S, Sikora SS, Kumar A, Saxena R, Kapoor VK (2004) Surgical management of corrosive strictures of stomach. Indian J Gastroenterol 23:178–180
Bonavina L, Chirica M, Skrobic O, Kluger Y, Andreollo NA, Contini S, Simic A, Ansaloni L, Catena F, Fraga GP, Locatelli C, Chiara O, Kashuk J, Coccolini F, Macchitella Y, Mutignani M, Cutrone C, Poli MD, Valetti T, Asti E, Kelly M, Pesko P (2015) Foregut caustic injuries: results of the world society of emergency surgery consensus conference. World J Emerg Surg 10:44. https://doi.org/10.1186/s13017-015-0039-0
Tseng YL, Wu MH, Lin MY, Lai WW (2002) Early surgical correction for isolated gastric stricture following acid corrosion injury. Dig Surg 19(4):276–280. https://doi.org/10.1159/000064582
Hwang TL, Chen MF (1996) Surgical treatment of gastric outlet obstruction after corrosive injury—can early definitive operation be used instead of staged operation? Int Surg 81:119–121
Shetty S, Desai PR, Bhabsar MS (2017) Surgical management of post corrosive acid ingestion symptomatic gastric outlet obstruction: single institute experience of 81 patients. Int Surgery Journal 4:3728–3731
C. Wastell. Long term clinical and metabolic effects of vagotomy with either gastrojejunostomy and or pyloroplasty. Hunterian Lecture, Royal College of Surgeons, England. 1969:204–208
Appelqvist P, Salmo M (1980) Lye corrosion carcinoma of the esophagus: a review of 63 cases. Cancer 45(10):2655–2658. https://doi.org/10.1002/1097-0142(19800515)45:10<2655::AID-CNCR2820451028>3.0.CO;2-P
Ti TK (1983) Oesophageal carcinoma associated with corrosive injury—prevention and treatment by oesophageal resection. Br J Surg 70(4):223–225. https://doi.org/10.1002/bjs.1800700413
Chibishev A, Davseva N, Shikole E (2012) Corrosive poisoning in adults. Journal of Academy of Medical Sciences of Bosnia and Herzegovina 24(2):125–130. https://doi.org/10.5455/msm.2012.24.125-130
Zamir O, Hod G, Lernau OZ, Mongle P, Nissan S (1985) Corrosive injury to stomach due to acid ingestion. American Surgeon 51(3):170–172
Soreide K, Sarr MG, Soreide JA (2006) Pyloroplasty for brnign gastric outlet obstruction-indications and techniques. Scandanavian Journal of Surgery 95:11–16
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Ray, D., Adak, A. Corrosive Poisoning Gastric Outlet Obstruction Treated by Early Definitive Surgery. Indian J Surg 83 (Suppl 3), 587–591 (2021). https://doi.org/10.1007/s12262-019-01989-y
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DOI: https://doi.org/10.1007/s12262-019-01989-y