Elective Surgery for Corrosive‐Induced Gastric Injury

Abstract

Gastric cicatrization is a well recognized late sequela of corrosive gastric injury, but the optimum timing and type of surgery for this complication are still unclear. Over a 7-year period (1988-1994) 34 patients underwent elective surgery for gastric lesions secondary to corrosive ingestion. A total of 18 (53%) patients had an associated esophageal stricture and presented with dysphagia, 15 (44%) patients had features of gastric outlet obstruction, 6 (18%) had diffuse gastric injury, and 28 (82%) had a segmental lesion. A tube jejunostomy was done in 23 (68%) patients to improve nutrition and resulted in a significant increase in weight and in the serum protein level after 8 weeks of tube feeding. Elective surgery was performed 3 to 24 months (average 7 months) after ingestion of the corrosive substance. Gastric resection was done in 20 (59%) patients and gastrojejunostomy (without vagotomy) in 11 (32%); at follow-up the latter group did not exhibit development of a stomal ulcer. In patients with an associated esophageal stricture, endoscopic dilatation was successful in 89% patients and simplified the surgical approach. In conclusion, the success of surgery for corrosive-induced gastric injury depends on selecting the right procedure and intervening at the appropriate time.

Management of pyloric stricture in children: endoscopic balloon dilatation and surgery

“…Caustic ingestion causes liquefaction or coagulation necrosis, followed by cicatrization, which is a progressive process. Consequently, surgical intervention is recommended at the end of the cicatrization period [13,14]. We think that the extent and depth of gastric injury are important factors that should be considered to predict the outcome and to plan the time and technique of surgery.…”

Management of Acid- and Alkali-Induced Esophageal Strictures in 79 Adults by Endoscopic Dilation: 8-Years’ Experience in New Delhi

“…Contrary to the situation in Western countries where alkali-induced strictures are more common, acid has been found to be a more frequent cause of strictures in India. Acid ingestion has been found to be a cause in less than 5% of the stricture cases in United States, while in India it has been found to be involved in about 70%-80% [4,[13][14][15][16]. Most of the ingestions in India are accidental rather than suicidal [15].…”

“…Most of the ingestions in India are accidental rather than suicidal [15]. The common acids ingested in India are sulfuric acid, hydrochloric acid, nitric acid, and carbolic acid [4,15,16], while in the U.S. alkalis such as sodium hydroxide, sodium hypochlorite, and sodium tripolyphosphates are easily available and are the common offenders along with acids such as oxalic acid and hydrofluoric acid [16]. In this study we aimed to determine the safety and efficacy of endoscopic dilation using Savary-Gilliard (SG) and balloon dilators in the management of corrosive esophageal strictures and compare results with regard to acid-vs. alkali-induced strictures.…”

“…Acid ingestion has been found to be a cause in less than 5% of the stricture cases in United States, while in India it has been found to be involved in about 70%-80% [4,[13][14][15][16]. Most of the ingestions in India are accidental rather than suicidal [15]. The common acids ingested in India are sulfuric acid, hydrochloric acid, nitric acid, and carbolic acid [4,15,16], while in the U.S. alkalis such as sodium hydroxide, sodium hypochlorite, and sodium tripolyphosphates are easily available and are the common offenders along with acids such as oxalic acid and hydrofluoric acid [16].…”

Corrosive acid injury of the stomach

“…The majority of victims are young and in their productive age group. Unlike in the West where most of these injuries are due to alkali, severe upper GI injuries due to acids are seen in countries like Sri Lanka, India, and Turkey [1][2][3][4]. They are less well documented.…”