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

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. 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. 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. 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

Pyloric obstruction following the ingestion of corrosive acid.

Pyloric obstruction is a well documented end result of ingestion of corrosive acid. Whereas the oesophageal mucosa is resistant to damage, the pyloric spasm and the resultant pooling of acid in the pre-pyloric region, causes injury to this area. The fibrosis of the gastric wall with motility disturbances, and the diminution of acid and pepsin production from damage to the glandular elements, would weigh against the addition of a vagotomy to the drainage procedure. A case of ingestion of concentrated sulphuric acid and the management of its late sequelae, are discussed.