Surgical management of gastric cicatrisation resulting from corrosive ingestion.
BACKGROUND
Caustic injury to the stomach can be complicated by gastric stenosis. We review our experience with surgical management of symptomatic gastric stenosis.


METHODS
This is a retrospective chart review of patients who underwent surgery for gastric stenosis within 6 weeks to 26 months following corrosive ingestion. The data analyzed included the extent of cicatrisation, surgical procedure performed and outcome. Preoperative evaluation in these patients included a barium contrast study and upper gastrointestinal endoscopy.


RESULTS
Main presenting symptoms were nonbilious vomiting, early satiety, dysphagia and significant weight loss. Antropyloric strictures were present in 28 (64%) patients, total gastric involvement was seen in 16 (36%) patients, associated esophageal stenosis was present in 18 (40.91%) patients. Surgical procedures performed included distal gastrectomy with Billroth1 reconstruction in 31.82%, distal gastrectomy with Roux-en-Y reconstruction in 20.45%, stricturoplasty in 11.36%, subtotal gastrectomy in 18.18% and total gastrectomy with pouch reconstruction in another 18.18% patients. Complications encountered were pneumonitis in 18.18%, wound infection in 11.36%, intra-abdominal infection, anastomotic breakdown, reactivation of pulmonary tuberculosis and dumping syndrome, each in 2.27% patients. One patient (2.27%) died.


CONCLUSIONS
Surgical procedure should be tailored according to the extent of gastric involvement. Surgical resection is feasible and safe. Our results suggest that satisfactory outcome could be expected with different therapeutic modalities based on degree of cicatrisation.
Gupta
Vikas
V
Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Wig
Jai D
JD
Kochhar
Rakesh
R
Sinha
Saroj K
SK
Nagi
Birinder
B
Doley
Rudra P
RP
Gupta
Rajesh
R
Yadav
Thakur D
TD
D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D002057:Burns, Chemical / Q000175:diagnosis / Q000601:surgery*; D002424:Caustics / Q000506:poisoning*; D002921:Cicatrix / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery*; D003251:Constriction, Pathologic / Q000139:chemically induced / Q000175:diagnosis / Q000601:surgery; D003287:Contrast Media; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D002424:Caustics; D003287:Contrast Media; D001466:Barium Sulfate