Surgical Management of Post-Corrosive Gastric Outlet Obstruction: Outcome Assessment in Adults and Pediatric Patients in Resource-Limited Settings

Abstract

Purpose:To evaluate the outcomes of surgical treatment in adult and pediatric patients with postcorrosive gastric outlet obstruction (GOO) in Yemen. Patients and Methods: A prospective observational study was conducted at the Al-Thawra Modern General Hospital in Sana'a, Yemen, from January 1, 2019, to January 31, 2023. The study included 77 patients, including both adults and children, who were admitted for surgical treatment of postcorrosive GOO. Data was collected from medical records, patient interviews, and follow-up visits. Results: Among the 77 patients, 77% (n=59) were pediatric patients and 23% (n=18) were adults. The mean age of the cohort was 10.6 years, with an average age of 4.12 years for pediatric patients and 30.8 years for adults. Accidental ingestion of acidic substances was the primary cause of postcorrosive GOO (97% of cases). Universal symptoms at presentation included vomiting, early satiety, and weight loss. Definitive surgery was performed in one stage in 95% of patients, with Mikulicz pyloroplasty being the most common procedure (82%) in pediatric cases, whereas gastrojejunostomy was mainly used in adults (67%). Postoperative complications occurred in 22% of patients, with vomiting, wound infection, and aspiration pneumonia being the most common. Anastomotic restricture occurred in two pediatric patients who required reoperation. The overall mortality rate in one pediatric patient was 1.3%. Improvement in GOO symptoms were observed in 96% of patients. Pediatric patients had a longer median hospital stay (6.5 days) than adult patients (6 days). Conclusion: Corrosive injuries, particularly in the pediatric population, are a significant issue in Yemen due to the unsafe storage of sulfuric acid. Early surgical intervention within 4 weeks after ingestion is recommended to prevent weight loss and prolong hospitalization. Further research and interventions are needed to prevent such injuries, improve public awareness, and regulate the sale and storage of corrosive substances.