Short Communication
Isolated corrosive pyloric stenosis without oesophageal involvement: An experience of 21 years

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Abstract

Background and study aims

Corrosive ingestion is common in Asia and it is a frequent cause of morbidity secondary to intense fibrotic reaction and stricture formation of the oesophagus. Isolated corrosive pyloric stenosis without oesophageal involvement is an uncommon phenomenon.

Patients and methods

All consecutive patients, with corrosive ingestion in the last two decades, were reviewed and analysed. Eleven out of 201 patients with corrosive ingestion had isolated gastric outlet obstruction.

Results

Patients’ age ranged from 11 to 29 years with a male:female ratio of 1.75:1. All patients developed pyloric stenosis following ingestion of solution of acids. Barium study revealed complete/near-complete gastric outlet obstruction in all patients. On laparotomy, there was gastric dilatation in 10 patients, who underwent posterior gastrojejunostomy, whereas the stomach was contracted in one patient, and hence anterior gastrojejunostomy was performed. Seven patients were completely relieved of their symptoms; persistent postprandial epigastric fullness and/or dyspepsia was observed in four patients whose gastrojejunostomy stoma was found adequate on barium study, suggestive of gastric motility disorder. We did not encounter gastrojejunostomy-related complication of stomal ulcer/stenosis in our patients.

Conclusion

Isolated corrosive pyloric stenosis is not as rare as is commonly thought. Gastrojejunostomy is effective, although a fair percentage of patients appear to develop gastric motility disorder secondary to corrosive injury.

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.

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