Short CommunicationIsolated corrosive pyloric stenosis without oesophageal involvement: An experience of 21 years
Introduction
Pyloric stenosis secondary to caustic ingestion was first described in 1828 by Robert and, since then, 200 cases have been reported [1]. Till 1950, only 140 cases were described in the world literature [2]. In 1959, a further survey by Nevin et al. [3] brought the total number of the reported cases to 170. Later on, 23 cases of corrosive pyloric stenosis requiring surgical intervention were reported between 1960 and 1981 [4].
Rare occurrence of these lesions following caustic ingestion prompted us to report our experience in a developing semi-urban area with numerous small-scale lock industries.
Section snippets
Patients and methods
All patients following ingestion of corrosive material were treated at Jawaharlal Nehru Medical College Hospital, a Secondary Care Centre, Aligarh Muslim University, Aligarh. A total of 201 patients with accidental/suicidal ingestion of corrosive material were seen in a period of 21 years with effect from January 1989 to December 2009, out of which only 11 patients were found to develop isolated gastric outlet obstruction without any involvement of the oesophagus (Table 1). All these 11 patients
Results
Our patients with isolated corrosive pyloric stenosis included adolescents (36.4%) and young adults (63.7%), and the overall male:female (M:F) ratio was 1.75:1. However, in the adolescent age group, the M:F ratio was 1:1, whereas in the young adult group, the M:F ratio was found to be 2.5:1. Acid ingestion was found accidental in 54.6% (all males), suicidal in 36.4% (males 25%; females 75%) and homicidal in 9.1%. Accidental ingestion was found two times more in young males than in male
Discussion
Severe injuries to the upper gastrointestinal (GI) tract from corrosive ingestion include erosions, oesophagitis, gastritis and even necrosis and sloughing; corrosive burn leads to intense fibrotic reaction and stricture formation of oesophagus and/or stomach [5], [6]. Corrosive ingestion is common in Asia [7], and it is a frequent cause of morbidity in India [8]. The incidence of gastric outlet obstruction has been reported from 10% [8] to 37.5% [9].
Aligarh, a semi-urban city (near the
Conflicts of interest
The authors declared that there was no conflict of interest.
References (51)
- et al.
Lye strictures of esophagus: analysis of 90 cases of lye ingestion
J Thorac Cardiovasc Surg
(1969) - et al.
Corrosive injury-induced gastric outlet syndrome: a changing spectrum of agents and treatment
J Pediatr Surg
(2001) - et al.
The management of gastric burn in children
J Thorac Cardiovasc Surg
(1969) - et al.
A case of zinc chloride ingestion
J Pediatr Surg
(1998) - et al.
Late sequelae of gastric acid injury
Am J Surg
(1985) - et al.
Preliminary experience with balloon dilatation of the pylorus
Gastrointest Endosc
(1984) Hydrostatic balloon dilatation of gastrointestinal stenosis: a national survey
Gastrointest Endosc
(1986)- et al.
Preliminary experience with hydrostatic balloon dilatation of gastric outlet obstruction
Gastrointest Endosc
(1986) - et al.
Long-term outcome of endoscopic dilation of non-malignant pyloric stenosis
Gastrointest Endosc
(1995) - et al.
Through-the-scope balloon dilatation for pyloric stenosis: long-term results
Gastrointest Endosc
(1996)
Endoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction
Gastrointest Endosc.
Endoscopic balloon dilation for benign gastric outlet obstruction with or without Helicobacter pylori infection
Gastrointest Endosc
Pyloric stenosis: an unusual complication of alkaline corrosive poisoning
Am J Roentgenol Radium Ther Nucl Med
Corrosive pyloric stenosis: A review of 140 cases
Ann Surg
Early and late roentgenologic findings in corrosive gastritis: report of case
Am J Roentgenol Radium Ther Nucl Med
Corrosive stricture of esophagus
Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history
Am J Gastroenterol
Corrosive ingestion in adults
J Clin Gastroenterol
Corrosive injury to upper gastrointestinal tract
Indian J Gastroenterol
Surgical management of corrosive strictures of stomach
Indian J Gastroenterol
Cicatricial gastric stenosis caused by corrosive ingestion
Aust N Z J Surg
Caustic stricture of the esophagus
Corrosive pyloric stenosis without oesophageal involvement in children
Annal Trop Paediatr
Pyloric stenosis caused by ingestion of corrosive substances: report of case
Surg Clin North Am
Gastric outlet obstruction without esophageal involvement; A late sequelae of acid ingestion in children
J Indian Assoc Pediatr Surg
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2020, Journal of Pediatric Surgery Case ReportsCitation Excerpt :The types of surgery which can be done are pyloroplasty, gastrojejunostomy and gastroduodenostomy surgery. But it depends upon the condition of patient, findings at laparotomy as well as surgeon's ability and judgment [10]. In this case, the patient came to emergency department after obstruction sign was appeared.
Surgical management of corrosive-induced gastric injury in children: 10 years' experience
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2018, World Journal of Surgery