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1
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Giordano A, Mastronardi M, Podda M, Bonavina L, Cuccurullo D, Anania G, Bergamini C, Galloro G, Hassan C, Parodi MC, Agresta F, Montori G, Sartelli M, Catena F, Fugazzola P, Ansaloni L, Marciano E, Geraci G, Maurano A, Avellino M, Massella A, Orlandini B. Diagnosis and management of caustic ingestion: an interdisciplinary nationwide cross-sectional survey from the Italian society of endoscopic surgery and new technologies (SICE), the Italian society of digestive endoscopy (SIED), the world society of emergency surgery-Italy chapter (WSESit), and the Italian society of surgical endoscopy and digestive diseases (ISSE). Updates Surg 2025:10.1007/s13304-025-02166-5. [PMID: 40080354 DOI: 10.1007/s13304-025-02166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 03/03/2025] [Indexed: 03/15/2025]
Abstract
Caustic ingestion (CI) in adults represents a potentially life-threatening condition. Diagnosis and management of CI in real life remain challenging. The aim of the survey is to evaluate on a national scale the multidisciplinary management of these patients. 24-item online Survey was sent to the mailing lists and social media of Italian Society of Endoscopic Surgery and New Technologies, Italian Society of Digestive Endoscopy, World Society of Emergency Surgery-Italy Chapter, and Italian Society of Surgical Endoscopy and Digestive Diseases. Overall, 240 subjects answered to the survey, corresponding to 22.1% of the total members of the scientific societies involved. 131 (54.5%) respondents evaluated fewer than ten CI patients per year. The recommendations provided by the WSES and SIED guidelines were followed by 133 (55.2%) and 83 (34.4%) participants, respectively. Emergency surgery was advocated by 180 (77.6%) of the respondents for patients with transmural necrosis or signs of perforation, using minimally invasive surgery in 47% of the cases and considering initial esophagojejunal anastomosis as safe in 33 (14.2%) of the responses. Our study is the first to provide real-life data on how the management of CI varies across Italian physicians, according to regional, institutional, and specialty-related factors. This survey highlights the need for standardized and uniform guidelines.
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Affiliation(s)
- Alessio Giordano
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Manuela Mastronardi
- Department of Medicine, Surgery and Health Sciences, General Surgery Unit, University Hospital of Trieste, Trieste, Italy
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Diego Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Gabriele Anania
- Department of Surgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Carlo Bergamini
- Emergency Surgery Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Giuseppe Galloro
- Department of Clinical Medicine, Surgery Digestive Surgical Endoscopy Unit, University of Naples Federico II, Naples, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Maria Caterina Parodi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Teaching Hospital San Martino, Genoa, Italy
| | - Ferdinando Agresta
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | - Giulia Montori
- Department of General Surgery, Ulss2 Marca Trevigiana, Vittorio Veneto, Treviso, Italy
| | | | - Fausto Catena
- Emergency and Trauma Surgery Unit, Bufalini Hospital, Cesena, Italy
| | - Paola Fugazzola
- Department of General and Emergency Surgery, Policlinico San Matteo, Pavia, Italy
| | - Luca Ansaloni
- Department of General and Emergency Surgery, Policlinico San Matteo, Pavia, Italy
| | | | - Girolamo Geraci
- Emergency and General Surgery Unit, Palermo University Hospital "P. Giaccone", Palermo, Italy
| | - Attilio Maurano
- Digestive Endoscopy Unit, Mercato San Severino Hospital, Mercato San Severino, Salerno, Italy
| | - Manuela Avellino
- Digestive Endoscopy Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
| | - Arianna Massella
- Emergency Endoscopy Unit, Verona University Hospital, Verona, Italy
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2
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Singh AK, Gunjan D, Dash NR, Poddar U, Gupta P, Jain AK, Lahoti D, Nayer J, Goenka M, Philip M, Chadda R, Singh RK, Appasani S, Zargar SA, Broor SL, Nijhawan S, Shukla S, Gupta V, Kate V, Makharia G, Kochhar R. Short-term and long-term management of caustic-induced gastrointestinal injury: An evidence-based practice guidelines. Indian J Gastroenterol 2025:10.1007/s12664-024-01692-1. [PMID: 39982600 DOI: 10.1007/s12664-024-01692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 09/15/2024] [Indexed: 02/22/2025]
Abstract
The Indian Society of Gastroenterology has developed an evidence-based practice guideline for the management of caustic ingestion-related gastrointestinal (GI) injuries. A modified Delphi process was used to arrive at this consensus containing 41 statements. These statements were generated after two rounds of electronic voting, one round of physical meeting, and extensive review of the available literature. The exact prevalence of caustic injury and ingestion in developing countries is not known, though it appears to be of significant magnitude to pose a public health problem. The extent and severity of this preventable injury to the GI tract determine the short and long-term outcomes. Esophagogastroduodenoscopy is the preferred initial approach for the evaluation of injury and contrast-enhanced computed tomography is reserved only for specific situations. Low-grade injuries (Zargar grade ≤ 2a) have shown better outcomes with early oral feeding and discharge from hospital. However, patients with high-grade injury (Zargar grade ≥ 2b) require hospitalization as they are at a higher risk for both short and long-term complications, including luminal narrowing. These strictures can be managed endoscopically or surgically depending on the anatomy and extent of stricture, expertise available and patients' preferences. Nutritional support all along is crucial for all these patients until nutritional autonomy is established.
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Affiliation(s)
- Anupam Kumar Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Deepak Gunjan
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Nihar Ranjan Dash
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Ajay Kumar Jain
- Department of Gastroenterology, Choithram Hospital and Research Center, Indore, 452 014, India
| | - Deepak Lahoti
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, New Delhi, 110 017, India
| | - Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Mahesh Goenka
- Institute of Gastrosciences and Liver Transplant, Apollo Multispeciality Hospitals, Kolkata, 700 054, India
| | | | - Rakesh Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Sreekanth Appasani
- Department of Gastroenterology and Hepatology, Krishna Institute of Medical Sciences, Secunderabad, 500 003, India
| | - Showkat Ali Zargar
- Department of Gastroenterology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, 190 011, India
| | - Sohan Lal Broor
- Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, 110 076, India
| | - Sandeep Nijhawan
- Department of Gastroenterology and Hepatology, Sawai Man Singh Medical College, Jaipur, 302 004, India
| | - Siddharth Shukla
- Department of Medicine and Gastroenterology, Base Hospital, Guwahati, 781 028, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vikram Kate
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605 006, India
| | - Govind Makharia
- Department of Gastroenterology and HNU, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Rakesh Kochhar
- Department of Gastroenterology and Hepatology, Paras Hospital, Panchkula, 134 109, India.
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Kalayarasan R, Durgesh S. Changing trends in the minimally invasive surgery for corrosive esophagogastric stricture. World J Gastrointest Surg 2023; 15:799-811. [PMID: 37342842 PMCID: PMC10277936 DOI: 10.4240/wjgs.v15.i5.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/06/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
Esophagogastric stricture is the troublesome long-term complication of corrosive ingestion with a significant adverse impact on the quality of life. Surgery remains the mainstay of therapy in patients where endoscopic treatment is not feasible or fails to dilate the stricture. Conventional surgical management of esophageal stricture is open esophageal bypass using gastric or colon conduit. Colon is the commonly used esophageal substitute, particularly in those with high pharyngoesophageal strictures and in patients with accompanying gastric strictures. Traditionally colon bypass is performed using an open technique that requires a long midline incision from the xiphisternum to the suprapubic area, with adverse cosmetic outcomes and long-term complications like an incisional hernia. As most of the affected patients are in the second or third decade of life minimally invasive approach is an attractive proposition. However, minimally invasive surgery for corrosive esophagogastric stricture is slow to evolve due to the complex nature of the surgical procedure. With advancements in laparoscopic skills and instrumentation, the feasibility and safety of minimally invasive surgery in corrosive esophagogastric stricture have been documented. Initial series have mainly used a laparoscopic-assisted approach, whereas more recent studies have shown the safety of a total laparoscopic approach. The changing trend from laparoscopic assisted procedure to a totally minimally invasive technique for corrosive esophagogastric stricture should be carefully disseminated to preclude adverse long-term outcomes. Also, well-designed trials with long-term follow-ups are required to document the superiority of minimally invasive surgery for corrosive esophagogastric stricture. The present review focuses on the challenges and changing trends in the minimally invasive treatment of corrosive esophagogastric stricture.
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Affiliation(s)
| | - Satish Durgesh
- Surgical Gastroenterology, JIPMER, Puducherry 605006, India
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Elhalaby EA, Halawa NAEA, Elhalaby IE, Shawky D, Hassan H, Almetaher HA. The safety and efficacy of the trans-umbilical approach for pyloroplasty in the management of post-acid corrosive gastric outlet obstruction in children. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastric outlet obstruction (GOO) may follow acid corrosive ingestion. Several surgical techniques have been reported after the failure of endoscopic dilatation. The aim of this study was to evaluate the feasibility and safety of Heinecke-Mikulicz pyloroplasty (HMP) through a circum-umbilical skin incision in children with pyloric stricture after accidental acid corrosive ingestion.
Results
Seven patients were males and 4 were females, their ages ranged from 17 months to 6 years at the time of definitive treatment. The surgery was completed successfully in all patients through the circum-umbilical incision. Vertical extension of skin incision was needed in one patient. The pylorus was grossly affected in 9 patients. Both pylorus and gastric antrum were involved in 2 patients. Nine patients had an excellent postoperative course with the cessation of vomiting and progressive weight gain. One patient developed postoperative recurrent stricture treated by gastrojejunostomy. Another patient with associated esophageal stricture responded to repeated endoscopic dilatation for the esophageal stricture and pyloroplasty for the pyloric stricture. No surgical site infection or wound dehiscence occurred in any patient.
Conclusion
Heinecke-Mikulicz pyloroplasty through a circum-umbilical approach is both feasible and safe in the majority of children with post-acid corrosive GOO. It is associated with satisfactory wound healing and excellent cosmetic outcome. Different techniques are recommended in cases of severe pyloric stricture associated with significant proximal gastric antral scarring.
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Abstract
Corrosive (caustic) material ingestion remains a major health issue, particularly in developing countries. The management strategy after corrosive ingestion should be planned according to the signs and symptoms. The management of corrosive ingestion based on endoscopic grading, nothing by mouth, and barium studies should be abandoned. With the new management protocol, esophageal stricture can be predicted with high accuracy using the simple new prognostic DROOL score (≤ 4) rather than endoscopic grading, reduced by immediate oral feeding as soon as the patient can swallow saliva instead of nothing by mouth, diagnosed earlier (10-14 days) by fluoro-endoscopic balloon-assisted esophageal examination for patients with persistent dysphagia instead of relying on a barium study (≥ 21 days), and adequately treated by initiating balloon dilation earlier during the same anesthesia procedure. Fluoroscopically guided balloon dilatation with large balloons (18-20 mm) seems to be safe, with a low frequency of complications and a high success rate. If dilatation fails after a few months, esophagectomy and replacement surgery using the stomach should be considered. The increased risk of developing esophageal carcinoma after ingestion of corrosive substances should be kept in mind.
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Affiliation(s)
- Ibrahim Uygun
- Department of Pediatric Surgery, Faculty of Medicine, Kutahya Health Sciences University, Evliya Celebi Training and Research Hospital, Merkez, 43040, Kutahya, Turkey.
| | - Salih Bayram
- Clinic of Pediatric Surgery, Artvin Government Hospital, Artvin, Turkey
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Soomro MA, Aftab M, Hasan M, Arbab H. Heineke-Mikulicz pyloroplasty for isolated pyloric stricture caused by corrosive ingestion in children. Pak J Med Sci 2020; 36:S87-S90. [PMID: 31933613 PMCID: PMC6943102 DOI: 10.12669/pjms.36.icon-suppl.1714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Corrosive ingestion in children is a common problem in low income countries. These agents cause injuries and later strictures of esophagus and stomach. Gastric outlet obstruction is known complication of acids and surgery is the mainstay of treatment. There are multitude of surgical options for these strictures depending on the involved segment of the stomach and experience of the surgeon. Here we present three cases of children who accidentally ingested acid stored in soda bottles and subsequently developed isolated pyloric strictures. These cases presented between August 2018 and April 2019 to our facility, a tertiary care hospital in Karachi, Pakistan. All three patients had an initial latent period of one to two weeks following corrosive ingestion, after which symptoms of gastric outlet obstruction appeared. Intraoperatively, all three had normal esophagus and antrum but scarred and strictured pylorus. Heineke-Mikulicz pyloroplasty was done in these cases without complications and the outcomes were satisfactory.
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Affiliation(s)
- Muhammad Aqil Soomro
- Dr. Muhammad Aqil Soomro, FCPS. Division of Pediatric Surgey, The Indus Hospital, Karachi, Pakistan
| | - Maryam Aftab
- Dr. Maryam Aftab, FCPS. Division of Pediatric Surgey, The Indus Hospital, Karachi, Pakistan
| | - Maria Hasan
- Dr. Maria Hasan, MBBS. Division of Pediatric Surgey, The Indus Hospital, Karachi, Pakistan
| | - Hana Arbab
- Dr. Hana Arbab, FCPS. Division of Pediatric Surgey, The Indus Hospital, Karachi, Pakistan
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Alser O, Hamouri S, Novotny NM. Esophageal caustic injuries in pediatrics: a sobering global health issue. Asian Cardiovasc Thorac Ann 2019; 27:431-435. [PMID: 30924683 DOI: 10.1177/0218492319842441] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Caustic material ingestion by children is considered a global healthcare issue, especially in low-to-middle income countries. The aim of this article was to review the epidemiology, prevention, and management of caustic material ingestion in pediatric patients, comparing low-to-middle income countries with high-income countries. We conducted an English literature review using PubMed with the following keywords: (caustic OR corrosive) AND ingestion AND (pediatric OR pediatric). Our search retrieved 253 citations; all abstracts were screened by the authors, and 52 articles were finally included in our review. Prevention is key in tackling this issue, but legislation is scarce in low-to-middle income countries. Diagnosis of caustic ingestion is mostly achieved using flexible endoscopy, computed tomography, and endoscopic ultrasound, but access is limited in low-to middle income countries and diagnosis is often delayed. After stabilizing patients, the mainstay of treatment is graded endoscopic dilatation, and rarely, esophageal replacement. We concluded that caustic ingestion represents a serious condition where prevention is the key. Once a child suffers an injury, rapid and careful evaluation of the injury with endoscopy, and a course of close observation and dilations if needed, will often avoid esophageal replacement. When necessary, the stomach is the best first option if it is viable, followed by the colon, and finally, the jejunum.
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Affiliation(s)
- Osaid Alser
- 1 Barts and The London School of Medicine and Dentistry, London, UK
| | - Shadi Hamouri
- 2 Department of Surgery and Urology, Jordan University of Science and Technology, Irbid, Jordan
| | - Nathan M Novotny
- 3 Beaumont Children's, Royal Oak, MI, USA.,4 Palestine Medical Complex, Ramallah, Palestine
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Seleim HM, Wishahy AMK, Abouelfadl MH, Farouk MM, Elshimy K, Fares AE, Kaddah SN, Eltagy G, Elbarbary MM. Laparoscopic Diamond Antroduodenostomy for Postcorrosive Pyloric Cicatrization: A Novel Approach. J Laparoendosc Adv Surg Tech A 2019; 29:538-541. [PMID: 30758265 DOI: 10.1089/lap.2018.0182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Traditionally, Billroth I procedure or bypass gastrojejunostomy were the recommended approaches for management of postcorrosive complete gastric outlet obstruction (GOO), whereas Heineke Mickulicz pyloroplasty was recommended for moderate mucosal injury with partial cicatrization. In this study, laparoscopic diamond antroduodenostomy was carried out as an alternative minimally invasive approach for cases with pyloric cicatricial obstruction. PATIENTS AND METHODS Between January and December 2017, children who were referred to Pediatric Surgery Department, Cairo University Hospital, with GOO as a consequence of caustic liquid ingestions were included in this study. Laparoscopic diamond antroduodenostomy was performed for the presented cases. RESULTS Through the year 2017, 5 cases were approached with laparoscopic diamond antroduodenostomy. Isolated pyloric cicatrization was evident in 4 cases, whereas synchronous insult to thoracic esophagus and pylorus was manifest in the fifth case. Laparoscopic feeding jejunostomy completed the procedure for the case with esophageal stricture. Contrast study-24 hour postoperatively-assured no radiological leaks in the presented cases, where enteral feeding was gradually commenced, and patients discharged home a day later. After a mean follow-up of 13.5 months, neither recurrence of obstructive symptoms nor dumping was displayed. Cosmetic outlook inherent to the minimally invasive approach was appreciated by the parents. CONCLUSION Laparoscopic diamond antroduodenostomy is a feasible approach for management of postcorrosive pyloric obstruction. It allowed early enteral feeding, with no dumping symptoms, in addition to the fundamental advantages of minimally invasive surgery. A bigger series and longer follow-up is recommended to verify the reported results.
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Affiliation(s)
- Hamed M Seleim
- 1 Department of Pediatric Surgery, Tanta University, Tanta, Egypt
| | | | | | - Moemen M Farouk
- 2 Department of Pediatric Surgery, Cairo University, Cairo, Egypt
| | - Khalid Elshimy
- 1 Department of Pediatric Surgery, Tanta University, Tanta, Egypt
| | - Ahmed E Fares
- 3 Department of Pediatric Surgery, Fayoum University, Fayoum, Egypt
| | - Sherif N Kaddah
- 2 Department of Pediatric Surgery, Cairo University, Cairo, Egypt
| | - Gamal Eltagy
- 2 Department of Pediatric Surgery, Cairo University, Cairo, Egypt
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9
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El-Asmar KM, Allam AM. Surgical management of corrosive-induced gastric injury in children: 10years' experience. J Pediatr Surg 2018; 53:744-747. [PMID: 28576428 DOI: 10.1016/j.jpedsurg.2017.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 01/28/2023]
Abstract
AIM The purpose of this study was to report surgical management and outcome of corrosive-induced gastric injuries in children at our institute over the last decade. PATIENTS & METHOD Medical records of patients admitted for corrosive-induced gastric injury at the Pediatric Surgery Department of Ain Shams University between January 2007 and January 2017 were retrospectively reviewed. RESULTS Twenty six cases (17 boys and 9 girls) were enrolled. Mean age was 3.61±1.29. Ingested agent was acid in all the patients. Main presenting symptom was gastric output obstruction in 22 cases. The interval between corrosive ingestion and presentation ranged from one to 135days (mean=43.9±34). Surgical procedure included total gastrectomy (n=2), partial gastrectomy (n=2), augmentation gastroplasty (n=1), Billroth I (n=2), antrectomy (n=2), antroplasty (n=3), gastrojejunostomy (n=2), Heineke-Mikulicz pyloroplasty (n=9), Finney pyloroplasty (n=5), and feeding jejunostomy (n=4). Anastomotic stricture requiring a second operation developed in one patient. There were three mortalities related to the associated esophageal strictures. The mean follow-up period is 3.5years. All patients are free of symptoms and gained adequate weight. CONCLUSION Surgery is the mainstay of management for corrosive-induced gastric injuries with good long-term results. Surgical procedure should be tailored according to the patient's general condition and extent of gastric injury. LEVEL OF EVIDENCE This is a case series with no comparison group (level IV).
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Affiliation(s)
| | - Ayman M Allam
- Pediatric Surgery Department, Ain Shams University, Cairo, Egypt
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10
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Serial Balloon Dilation to Relieve Gastric Outlet Obstruction Induced by the Ingestion of Toilet Cleaner. J Pediatr Gastroenterol Nutr 2018; 66:e56. [PMID: 29356772 DOI: 10.1097/mpg.0000000000001126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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11
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Chao HC. Update on endoscopic management of gastric outlet obstruction in children. World J Gastrointest Endosc 2016; 8:635-645. [PMID: 27803770 PMCID: PMC5067470 DOI: 10.4253/wjge.v8.i18.635] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/18/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
Endoscopic balloon dilatation (EBD) and surgical intervention are two most common and effective treatments for gastric outlet obstruction. Correction of gastric outlet obstruction without the need for surgery is an issue that has been tried to be resolved in these decades; this management has developed with EBD, advanced treatments like local steroid injection, electrocauterization, and stent have been added recently. The most common causes of pediatric gastric outlet obstruction are idiopathic hypertrophic pyloric stenosis, peptic ulcer disease followed by the ingestion of caustic substances, stenosis secondary to surgical anastomosis; antral web, duplication cyst, ectopic pancreas, and other rare conditions. A complete clinical, radiological and endoscopic evaluation of the patient is required to make the diagnosis, with complimentary histopathologic studies. EBD are used in exceptional cases, some with advantages over surgical intervention depending on each patient in particular and on the characteristics and etiology of the gastric outlet obstruction. Local steroid injection and electrocauterization can augment the effect of EBD. The future of endoscopic treatment seems to be aimed at the use of endoscopic electrocauterization and balloon dilatations.
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12
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Endoscopic Treatment of Gastric Outlet Obstruction Secondary to Accidental Acid Ingestion in a Child. J Pediatr Gastroenterol Nutr 2016; 62:90-2. [PMID: 26252917 DOI: 10.1097/mpg.0000000000000936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Accidental corrosive ingestion is not rare in pediatric patients in developing countries. We report a case of gastric outlet obstruction after the accidental ingestion of an acidic substance by a child who was successfully treated with endoscopic balloon dilatation.
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13
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Uygun I. Caustic oesophagitis in children: prevalence, the corrosive agents involved, and management from primary care through to surgery. Curr Opin Otolaryngol Head Neck Surg 2015; 23:423-432. [PMID: 26371603 DOI: 10.1097/moo.0000000000000198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Caustic substance ingestion (CSI) remains a major health issue, particularly in developing countries, where laws are not effectively enforced. This review offers a thorough analysis of the current epidemiology, clinical features, management, treatment, and long-term complications of CSI in children. RECENT FINDINGS Strong alkalis sold in liquid and granular forms, particularly crystalline grease cleaners (concentrated sodium hydroxide), are the principal causes of severe oesophageal damage. Currently, early endoscopy to assess the gastro-oesophageal mucosa is not considered necessary for all CSI cases. Oesophageal stricture is a major complication developing after CSI, and should be diagnosed and treated earlier, 10-14 days after CSI via commencement of a dilation program. Fluoroscopically guided oesophageal balloon dilatation seems to be safe, with a low frequency of complications and a high success rate. However, it should commence earlier than is currently the case, and should be performed gently, using balloons of gradually increasing diameter. If dilation fails after a few months, oesophageal replacement surgery should be performed. SUMMARY Unfortunately, neither dilatation treatment nor oesophageal bypass surgery can prevent the development of oesophageal carcinoma, the incidence of which is high after CSI. The continuing unacceptably high incidence of CSI accidents would be reduced if corrosive materials were sold in their original childproof containers, highlighting the need for preventive and adult education programmes.
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Affiliation(s)
- Ibrahim Uygun
- Department of Paediatric Surgery, Medical Faculty of Dicle University, Sur, Diyarbakir, Turkey
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14
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Kluger Y, Ishay OB, Sartelli M, Katz A, Ansaloni L, Gomez CA, Biffl W, Catena F, Fraga GP, Di Saverio S, Goran A, Ghnnam W, Kashuk J, Leppäniemi A, Marwah S, Moore EE, Bala M, Massalou D, Mircea C, Bonavina L. Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion. World J Emerg Surg 2015; 10:48. [PMID: 26478740 PMCID: PMC4609064 DOI: 10.1186/s13017-015-0043-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/09/2015] [Indexed: 12/15/2022] Open
Abstract
Caustic material ingestion injuries (CMI) are uncommon. Only 5,000 cases are reported in the United States each year and most acute care healthcare facilities admit only a few cases annually. Accordingly, no single institution can claim extensive experience, and management protocols are most probably based on either expert opinion or literature reports. In this study, we will attempt to review opinions and practices of representatives of the board members of the World Society of Emergency Surgery and compare them to the current literature.
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Affiliation(s)
- Yoram Kluger
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | - Ofir Ben Ishay
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | | | - Amit Katz
- />Rambam Health Care Center, POB 9602, Haifa, 31096 Israel
| | | | - Carlos Augusto Gomez
- />Hospital Universitário Therezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Universidade Federal de Juiz de Fora (UFJF), Minas Gerais Jiiz de Fora, Brazil
| | - Walter Biffl
- />Department of Surgery, University of Florida, Gainesville, Florida USA
| | | | - Gustavo P. Fraga
- />Faculdade de Ciências Médicas (FCM), Unicamp Campinas, Jiiz de Fora, Brazil
| | | | - Augustin Goran
- />Department of Surgery, University Hospital Center, Zagreb, Croatia
| | - Wagih Ghnnam
- />Mansoura Faculty of Medicine, Mansoura University Egypt, Mansoura, Egypt
| | - Jeffry Kashuk
- />Assia Medical Group, Assuta Medical Centers, Tel Aviv, Israel
| | | | - Sanjay Marwah
- />Department of Surgery, Post-graduate Institute of Medical Sciences, Rohtak, India
| | - Ernest E. Moore
- />Department of Surgery, Denver Health Medical Center, Denver, USA
| | - Miklosh Bala
- />Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Damien Massalou
- />Hôpital St Roch 5, Université Nice Sophia-Antipolis, Nice, France
| | - Chirica Mircea
- />Department of General, Endocrine and Digestive Surgery, Saint-Louis Hospital, Université Paris, Paris, France
| | - Luigi Bonavina
- />Policlinico San Donato, University of Milan School of Medicine, Milan, Italy
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15
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Losada M M, Rubio M M, Blanca G JA, Pérez A C. [Ingestion of caustic substances in children: 3 years of experience]. ACTA ACUST UNITED AC 2015; 86:189-93. [PMID: 26363860 DOI: 10.1016/j.rchipe.2015.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 03/10/2015] [Indexed: 01/21/2023]
Abstract
INTRODUCTION There is no clear consensus on the management of accidental ingestion of caustic substances in paediatrics. The aim of this study was to determine the profile of the paediatric population treated due to caustic ingestion in a Healthcare Centre. PATIENTS AND METHOD A descriptive study was conducted on patients treated for the ingestion of caustic substances in our hospital during the period 2008-2011. RESULTS A total of 12 patients were treated, with a mean age of 3.8 years (1-13 years), with the majority males (58.8%). An alkaline product was ingested by 58.3%, and an acid by 41.6%. The majority (58.3%) did not refer to symptoms and the remainder referred to vomiting (33.3%), odynophagia (16.6%), haematemesis (8.3%), hyper-salivation (8.3%) and shortness of breath (8.3%). Oral cavity lesions were observed in 75% of cases. All, except one, were accidental. An endoscopy was performed on all of them (100%) between 12 and 24hours post-ingestion, with pathological findings in 41.6%. In the group that ingested an alkali, 2 (16.6%) patients had lesions, one a grade 2B and one a grade 3 oesophagitis. In the acid ingestion group, 4 (33.3%) patients had lesions; one grade 1-2A oesophagitis, two acute non-erosive gastritis, and one acute haemorrhagic gastritis. A follow-up endoscopy was performed depending on the previous endoscopic findings. Only two patients presented with complications. CONCLUSIONS Emphasis is placed on the endoscopic evaluation in the first 24hours of deliberate asymptomatic ingestions, as well as a strict follow-up in those that ingested acids, due to delayed associated lesions.
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Affiliation(s)
- María Losada M
- Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen Macarena, Sevilla, España
| | - María Rubio M
- Sección de Digestivo y Nutrición Infantil, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Infantil Virgen del Rocío, Sevilla, España.
| | - Jose Antonio Blanca G
- Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
| | - Cristina Pérez A
- Unidad de Gestión Clínica de Pediatría, Hospital Universitario Puerta del Mar, Cádiz, España
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16
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Abstract
Caustic ingestion continues to be a significant problem world-wide especially in developing countries and particularly in the under 6 years age group. The presence or absence of symptoms or oral lesions does not reliably predict the existence or severity of oesophageal lesions. Upper endoscopy remains the mainstay diagnostic modality for evaluation to define the extent and severity of the injury. The best predictor of morbidity and mortality is the extent of injury as assessed during initial evaluation. Early management strategies for caustic ingestion are well defined. Controversy still surrounds the use of steroids, antibiotics, antacid therapy in the acute phase, and the use of oesophageal stents and the frequency, timing and method of dilatation in the prevention and management of oesophageal strictures. There is a pressing need for non-invasive diagnostic modalities and effective therapeutic options to evaluate and treat the complications associated with caustic ingestion. Indications for definitive surgery or bypass and the type of procedure to use are also subject to ongoing debate.
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17
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Bajpai M, Singh A, Panda SS, Chand K, Rafey AR. Hypertrophic pyloric stenosis in an older child: a rare presentation with successful standard surgical management. BMJ Case Rep 2013; 2013:bcr-2013-201834. [PMID: 24259530 DOI: 10.1136/bcr-2013-201834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infantile hypertrophic pyloric stenosis is a disease of neonatal period usually manifest between the third and fourth weeks of life. Metabolic alkalosis and paradoxical aciduria are two common sequel of this entity. We report an unusual case of an 8-year-old boy who presented with recurrent, long-standing episodes of non-bilious vomiting and poor weight gain without any other metabolic derangement.
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Affiliation(s)
- Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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18
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Contini S, Scarpignato C. Caustic injury of the upper gastrointestinal tract: a comprehensive review. World J Gastroenterol 2013; 19:3918-3930. [PMID: 23840136 PMCID: PMC3703178 DOI: 10.3748/wjg.v19.i25.3918] [Citation(s) in RCA: 199] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/24/2013] [Accepted: 04/27/2013] [Indexed: 02/07/2023] Open
Abstract
Prevention has a paramount role in reducing the incidence of corrosive ingestion especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported and their true prevalence simply cannot be extrapolated from random articles or personal experience. The specific pathophysiologic mechanisms are becoming better understood and may have a role in the future management and prevention of long-term consequences, such as esophageal strictures. Whereas the mainstay of diagnosis is considered upper gastrointestinal endoscopy, computed tomography and ultrasound are gaining a more significant role, especially in addressing the need for emergency surgery, whose morbidity and mortality remains high even in the best hands. The need to perform emergency surgery has a persistent long-term negative impact both on survival and functional outcome. Medical or endoscopic prevention of stricture is debatable, yet esophageal stents, absorbable or not, show promising data. Dilatation is the first therapeutic option for strictures and bougies should be considered especially for long, multiple and tortuous narrowing. It is crucial to avoid malnutrition, especially in developing countries where management strategies are influenced by malnutrition and poor clinical conditions. Late reconstructive surgery, mainly using colon transposition, offers the best results in referral centers, either in children or adults, but such a difficult surgical procedure is often unavailable in developing countries. Possible late development of esophageal cancer, though probably overemphasized, entails careful and long-term endoscopic screening.
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19
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Gobbi D, Billi P, Fascetti Leon F, Alvisi P, Lambertini A, Lima M. Pneumatic pyloric dilatation for the treatment of gastric outlet obstruction in a child. Pediatr Int 2013; 55:382-5. [PMID: 23782371 DOI: 10.1111/ped.12022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2011] [Revised: 03/22/2012] [Accepted: 09/03/2012] [Indexed: 01/01/2023]
Abstract
Acquired causes of gastric outlet obstruction (GOO) are rarely encountered in infancy, having an approximate incidence of 1 per 100,000 live births. Reports of short-term exposure to non-steroidal anti-inflammatory drugs having adverse events are few. We present the case of a previously healthy 3-year-old boy who developed severe chronic gastric outlet obstruction and antral stenosis after a short-term ingestion of liquid ibuprofen at a dosage not thought to be associated with unfavorable effects. Even though the optimal management of these cases remains to be determined, we report on a prompt and successful endoscopic treatment for this condition.
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Affiliation(s)
- Dalia Gobbi
- Department of Paediatric Surgery, University of Bologna, Bologna, Italy.
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20
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Temiz A, Oguzkurt P, Ezer SS, Ince E, Hicsonmez A. Predictability of outcome of caustic ingestion by esophagogastroduodenoscopy in children. World J Gastroenterol 2012; 18:1098-103. [PMID: 22416185 PMCID: PMC3296984 DOI: 10.3748/wjg.v18.i10.1098] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 01/16/2012] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the necessity of esophagogastroduodenoscopy (EGD) to predict the outcome of caustic ingestion in children.
METHODS: The study included 206 children who underwent EGD because of ingestion of caustic substances between January 2005 and August 2010. Retrospective analysis of data of the patients was performed.
RESULTS: The male/female ratio was 1.6 and mean age was 38.1 ± 28.8 mo. The caustic substances were acidic in 72 (34.9%) cases, alkaline in 56 (27.2%), liquid household bleach in 62 (30.1%), and unknown in 16 (7.8%). Fifty-seven (27.7%) patients were symptom-free. Significant clinical findings were observed in 149 (72.3%) patients. Upper gastrointestinal endoscopy findings of esophageal injury were grade 0 in 86 (41.7%) patients, grade 1 in 49 (23.8%), grade 2a in 42 (20.4%), grade 2b in 28 (13.6%), and grade 3a in 1 (0.5%) patient. 35 patients with grade 2a, 2b, and 3a injuries underwent esophageal dilation at second week of ingestion. Esophageal stricture, which necessitated a regular dilation program developed in 13 of the aforementioned 35 patients. There is no statistically significant difference in the rate of development of esophageal stricture between the patients who ingested acidic (15.3%) and alkaline (8.9%) substances (P = 0.32). Severe gastric injury was detected in 38 (18.5%) patients. The rate of development of gastric injury was significantly higher in the acidic group (14%) than in the alkaline group (2.9%) (P = 0.001). Out of 149 patients with clinical findings, 49 (32.9%) patients had no esophageal injury and 117 (78.5%) patients had no gastric lesion. Esophageal and severe gastric injuries were detected in 20 (35.1%) and 8 (14%) of patients with no clinical findings respectively. Pyloric stenosis developed in 6 patients. Pyloric obstruction improved with balloon dilation in 2 patients. Mean hospitalization time were 1.2 ± 0.5 d for grade 0 and 2.3 ± 5 d for grade 1 and 6.3 ± 6.2 d for grade 2a and 15.8 ± 18.6 d for grade 2b. It was significantly longer for patients with grade 2a and 2b injuries (P = 0.000).
CONCLUSION: Endoscopy is an effective technique for determining the presence of esophageal and gastric damage and to avoid unnecessary treatment in patients with no or mild injury.
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21
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Temiz A, Oguzkurt P, Ezer SS, Ince E, Gezer HO, Hicsonmez A. Management of pyloric stricture in children: endoscopic balloon dilatation and surgery. Surg Endosc 2012; 26:1903-8. [PMID: 22234589 DOI: 10.1007/s00464-011-2124-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 12/05/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical correction is the most preferred treatment modality in pyloric stricture (PS). Recently a few studies reported the experience of balloon dilation in children with PS. This study was designed to present our experiences of the management of the patients with PS with balloon dilation and corrective surgery. METHODS The records of 14 patients who were treated with the diagnosis of PS between August 2003 and August 2011 were reviewed retrospectively. RESULTS There were nine boys and five girls (mean age, 3.4 ± 1.7 years). The history of caustic ingestion was detected in eight patients; six of them were admitted on the day of ingestion. Two patients were admitted with nonbilious vomiting more than 2 weeks after ingestion. Four patients did not have a remarkable medical history, including caustic ingestion. They admitted with the complaint of nonbilious vomiting. PS was detected during endoscopy in two patients who had a diagnosis of peptic ulcer disease. PS was shown by barium meal study in all patients. Endoscopy was performed in all patients. Endoscopic balloon dilation was tried in 12 patients. Overall eight patients required surgical procedures for PS. The complaints were resolved by endoscopic balloon dilation of pylorus in the remaining six patients. CONCLUSIONS Although endoscopic balloon dilatation for benign PS in adults is a generally accepted method of treatment, there is less experience with endoscopic balloon dilatation for PS in children. PS due to benign disorders can be effectively and successfully treated through endoscopic balloon dilatation in suitable patients. In patients with successful pyloric balloon dilatation, surgery can be avoided.
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Affiliation(s)
- Abdulkerim Temiz
- Department of Pediatric Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.
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22
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Abstract
Caustic ingestion continues to be a significant problem worldwide especially in developing countries. In 2008 over 200,000 exposures to caustic substances were reported to the National Poison Data System. The presence or absence of symptoms or oral lesions does not predict the existence or severity of lesions. The best predictor of morbidity and mortality is the extent of injury as assessed during initial evaluation. Upper endoscopy remains the mainstay diagnostic modality for the evaluation of patients with caustic ingestion. There is a pressing need for noninvasive diagnostic modalities and effective therapeutic options to evaluate and treat the complications associated with caustic ingestion.
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Affiliation(s)
- Mortada Elshabrawi
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, The University of Arizona, Tucson, AZ 85750, USA
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23
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Self-expandable metal stenting of refractory upper gut corrosive strictures: a new role for endoscopy? Case Rep Gastrointest Med 2011; 2011:346413. [PMID: 22606415 PMCID: PMC3350195 DOI: 10.1155/2011/346413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/15/2011] [Indexed: 12/26/2022] Open
Abstract
Caustic strictures of the gastrointestinal tract are often difficult to treat, since relapses are frequent after medical or endoscopic treatment. Thus, novel approaches are needed. We report here our experience with self-expandable metallic stents (SEMS) as a new endoscopic approach in three patients with corrosive strictures of the upper gastrointestinal tract.
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24
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Shukla RM, Mukhopadhyay M, Tripathy BB, Mandal KC, Mukhopadhyay B. Pyloric and antral strictures following corrosive acid ingestion: A report of four cases. J Indian Assoc Pediatr Surg 2011; 15:108-9. [PMID: 21124669 PMCID: PMC2980922 DOI: 10.4103/0971-9261.71749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This study reports four children who developed complete stricture of pylorus and antrum of the stomach following accidental ingestion of corrosive agent (toilet cleaner).
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Affiliation(s)
- Ram Mohan Shukla
- Department of Pediatric Surgery, N. R. S. Medical College and Hospital, Kolkata 14, India
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25
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Ansari MM, Haleem S, Harris SH, Khan R, Zia I, Beg MH. Isolated corrosive pyloric stenosis without oesophageal involvement: an experience of 21 years. Arab J Gastroenterol 2011; 12:94-8. [PMID: 21684482 DOI: 10.1016/j.ajg.2011.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 03/11/2011] [Accepted: 04/06/2011] [Indexed: 01/30/2023]
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.
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26
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27
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Ozokutan BH, Ceylan H, Ertaşkin I, Yapici S. Pediatric gastric outlet obstruction following corrosive ingestion. Pediatr Surg Int 2010; 26:615-8. [PMID: 20443118 DOI: 10.1007/s00383-010-2613-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE Corrosive substance ingestion is still a major medical and social problem for children. Gastric injury after corrosive ingestion is relatively uncommon as compared with esophageal injury. Gastric outlet obstruction (GOO) is a significant complication of corrosive ingestion. METHODS Medical records of 20 consecutive patients with GOO due to corrosive ingestion during an 8-year period between 2002 and 2009 were retrospectively reviewed. RESULTS There were 10 boys and 10 girls with a mean age of 5.1 years (1.5-15 years). Ingested material was acid in all the patients. Two patients had associated esophageal stricture. The mean time between the ingestion and the development of GOO was 27.8 days (range 21-45 days) and all the patients presented with postprandial epigastric distension, nonbilious vomiting and weight loss. Surgical treatment included gastroduodenostomy (n = 8), Billroth I (n = 7), pyloroplasty (n = 5), and gastrojejunostomy (n = 2) procedures for GOO. Anastomotic stricture requiring a second operation developed in two patients. There was no surgical mortality. The mean follow-up is 3.3 years and all patients are free of symptoms. CONCLUSION GOO is one of the most common gastric complications of corrosive ingestion that may require surgical treatment. Prevention of corrosive ingestion has great importance to avoid such complications.
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Affiliation(s)
- B H Ozokutan
- Department of Pediatric Surgery, Gaziantep University Medical Faculty, 27310, Gaziantep, Turkey.
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28
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Sachdev A, Gupta M, Attri AK. Gastro-colic Fistula due to Acid Ingestion. Gastroenterology Res 2010; 3:50-51. [PMID: 27956986 PMCID: PMC5139841 DOI: 10.4021/gr2010.02.173e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/04/2010] [Indexed: 11/16/2022] Open
Abstract
Corrosive ingestion can cause serious damage to the upper gastrointestinal tract. The acute consequences could range from mild erythema to gangrene and perforation. Delayed consequences could be strictures of the oesophagus presenting as dysphagia or gastric, pyloric and antral stenosis presenting as gastric outlet obstruction. Gastro-colic fistula as a complication of acid ingestion is a rare clinical entity. We report this case of a patient who presented with complaints of dysphagia and recurrent vomiting of foul smelling brownish vomitus two months following suicidal acid (sulphuric acid) ingestion. The presence of a gastro-colic fistula was confirmed with a barium meal examination.
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Affiliation(s)
- Atul Sachdev
- Department of Medicine, Government Medical College and Hospital Chandigarh, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital Chandigarh, India
| | - Ashok Kumar Attri
- Department of Surgery, Government Medical College and Hospital Chandigarh, India
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29
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Gupta V, Wig JD, Kochhar R, Sinha SK, Nagi B, Doley RP, Gupta R, Yadav TD. Surgical management of gastric cicatrisation resulting from corrosive ingestion. Int J Surg 2009; 7:257-61. [PMID: 19401241 DOI: 10.1016/j.ijsu.2009.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 04/12/2009] [Accepted: 04/18/2009] [Indexed: 02/08/2023]
Abstract
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. CONCLUSION 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.
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Affiliation(s)
- Vikas Gupta
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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30
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Sharma KK, Ranka P, Goyal P, Dabi DR. Gastric outlet obstruction in children: an overview with report of Jodhpur disease and Sharma's classification. J Pediatr Surg 2008; 43:1891-7. [PMID: 18926227 DOI: 10.1016/j.jpedsurg.2008.07.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 07/04/2008] [Accepted: 07/04/2008] [Indexed: 01/05/2023]
Abstract
BACKGROUND/PURPOSE Gastric outlet obstruction (GOO) is overwhelmingly described as infantile hypertrophic pyloric stenosis that overshadows other causes; thereby, there is a need to develop an elaborate and comprehensive classification. We present the same and establish a new disease called primary acquired gastric outlet obstruction during infancy and childhood that was reported for the first time by us in 1997, reviewing the literature published since then, with report of our new cases. METHODS Eight patients of this disease presented at our center from 1996 to May 2008, and these were analyzed epidemiologically and clinically. Other reports published in literature were compared, and all reported patients were compiled. RESULTS All 8 cases presented at age ranging from 1 month to 6 years, with mean age of 2.9 years; there was predilection for male sex (male, 7; female, 1). Presenting symptoms and signs were nonbilious vomiting, weight loss, dehydration, dyselectrolytemia, abdominal pain, and visible gastric peristalsis. Upper gastrointestinal contrast study showed large stomach and increased gastric emptying time. Endoscopy displayed normal stomach without intraluminal lesion. Exploration revealed a dilated stomach, without any pyloric muscular hypertrophy, scarring, inflammation, or obstruction externally or intraluminally. Result of histopathologic examination was normal. All patients except 1 (died of unrelated cause) were cured by Heineke-Mikulicz pyloroplasty. CONCLUSIONS These patients represent a new disease entity designated as primary acquired gastric outlet obstruction during infancy and childhood. Author's classification is complete and scientific, encompassing all rare causes of GOO. We nickname this idiopathic variety of GOO the Jodhpur disease, the place of the first cases.
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Affiliation(s)
- Kamlesh Kumar Sharma
- Department of Pediatric Surgery, Pediatric Medicine and Anaesthesia, Regional Institute of Maternal and Child Health, Umaid Hospital, Dr SN Medical College, Jodhpur, Rajasthan 342003, India.
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31
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Clinical evaluation and management of caustic injury in the upper gastrointestinal tract in 95 adult patients in an urban medical center. Surg Endosc 2007; 22:1119-25. [PMID: 17965918 DOI: 10.1007/s00464-007-9620-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Revised: 07/23/2007] [Accepted: 08/29/2007] [Indexed: 12/20/2022]
Abstract
BACKGROUND Caustic ingestion causes a wide spectrum of injuries; appropriate treatment varies according to the severity and extent of the injury. This retrospective study of adult patients with caustic injury presents the endoscopic findings, treatment regimen, and clinical outcome. METHODS Over a 28-year period, 95 consecutive adult patients admitted to an urban emergency hospital for ingestion of caustic materials were studied. Each patient underwent early endoscopy and the injury was graded for severity. There were 61 men and 34 women with an average age of 37.2 years (range 17 to 81). Ingestion was due to a suicide attempt in 49 patients and accidental in 46 patients. RESULTS Ten patients showed no mucosal damage. The remaining 85 patients had grade I superficial injury in 47 patients, grade II moderate injury in 25 patients, and deep grade III injury in 13 patients. The ingestion of strong acid or strong alkali often produced deep grade III changes while bleach, detergent, ammonia or other substances usually caused grade I injury. Operative interventions were required for 11 patients with grade III injury and 6 patients with grade II injury. Endoscopic grading was predictive for the onset of complications including late esophageal stricture. There were no complications due to endoscopy; one patient with grade III and multiple comorbidities died from multiple organ failure. CONCLUSION Upper gastrointestinal endoscopy after caustic ingestion should be performed early to define the extent of injury and guide appropriate therapy. Grade I injuries heal spontaneously. Grade II injuries may be treated conservatively but repeat endoscopy helps define when intervention is needed. Grade III injuries ultimately require surgical intervention.
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Hameury F, Mcheik J, Lardy H, Gaudin J, Petit T, Ravasse P, Robert M, Maurage C, Levard G. Sténose acquise non hypertrophique du pylore chez l'enfant. Arch Pediatr 2007; 14:330-3. [PMID: 17187970 DOI: 10.1016/j.arcped.2006.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2006] [Accepted: 11/13/2006] [Indexed: 11/16/2022]
Abstract
UNLABELLED Pediatric non hypertrophic pyloric stenosis (NHPS) are uncommon. Their causes and treatments are debated. MATERIAL AND METHOD Retrospective review of all cases of NHPS from 3 pediatric surgery services during the period 1984-2002. RESULTS Six children, aged 17 months to 15 years, underwent surgery for NHPS. Clinical symptoms, food vomiting and loss of weight, were present for several weeks before the diagnosis of NHPS was made. The diagnosis was peptic stenosis in 3 cases and has not been established in 3 cases. Search for Helicobacter pylori was negative in all cases. Failure of specific medical treatment and endoscopic dilatations led to pyloric resection in 3 cases and pyloroplasty in 3 cases. Post operative course was uneventful with normal oral feeding and normalisation of weight status. Histologic data were aspecific. No recurrence was observed. DISCUSSION We discuss the origin of the pyloric stenosis, regarding clinical, operative and pathological data: were the stenosis the cause or consequence of peptic ulcer? Peptic disease is always advocated, but difficult to prove and may be excessively incriminated. Late symptomatic congenital and acquired idiopathic pyloric stenosis should be recalled. In all cases of proved pyloric stenosis, after failure of medical and endoscopic treatment, a simple surgical procedure (pyloroplasty) associated with medical treatment seems to be effective. CONCLUSION The diagnosis of NHPS should be suspected in a child with food vomiting and loss of weight if his age is not concordant with hypertrophic pyloric stenosis. Upper gastro-intestinal series and endoscopy are diagnostic. The precise cause of the stenosis is more difficult to asses. When the medical treatment fails, a pyloroplasty is usually curative.
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Affiliation(s)
- F Hameury
- Département médicochirurgical de pédiatrie, hôpital J.-Bernard, CHU de Poitiers, 2 rue de la Milétrie, BP 577, 86021 Poitiers cedex, France
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Sarioglu-Buke A, Corduk N, Atesci F, Karabul M, Koltuksuz U. A different aspect of corrosive ingestion in children: socio-demographic characteristics and effect of family functioning. Int J Pediatr Otorhinolaryngol 2006; 70:1791-8. [PMID: 16839614 DOI: 10.1016/j.ijporl.2006.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 06/01/2006] [Accepted: 06/07/2006] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Corrosive ingestion is thoroughly investigated in terms of its complications and treatment modalities but to date family functioning, behavior, attitude and knowledge of mothers of children who ingested corrosives has not been investigated and socio-demographic data has rarely been mentioned. Therefore a study was planned to investigate the socio-demographic data, family functioning, knowledge, behavior and attitude of mothers of children who ingested corrosive materials. METHODS The mothers of 50 children who ingested corrosive materials and 60 controls were asked to answer a questionnaire which included socio-demographic data and questions about their attitude, behavior and knowledge of corrosive ingestion. The mothers were also asked to reply family assessment device (FAD) and parental attitude research instrument (PARI). RESULTS The average ages of the children were 5.31+/-2.32 in the corrosive group with an M:F ratio of 1:1. The level of education of both mothers (p=0.000) and fathers (p=0.000) in the corrosive group were lower than that of the controls. There was no difference between the two groups in terms of number of working mothers (p=0.085). In the corrosive group the families used to have three or more children (42%) and the socioeconomic status of this group was lower than the controls (p=0.001). In the corrosive group these substances were purchased unlabeled (64%) and kept mainly in coke bottles. The affective involvement dimension of the FAD and the attitude of over-parenting and democratic attitude dimensions of the PARI tests were significantly different in the corrosive group among mothers from lower educational level whereas no difference was detected among mothers from higher educational level in this regard. CONCLUSION It was found that both level of education of the parents and socioeconomic factors played important role in shaping the habits that might lead to corrosive ingestion in children. For the prevention of corrosive ingestion broad based strategies including education are required.
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Affiliation(s)
- Akile Sarioglu-Buke
- Pamukkale University, Faculty of Medicine, Department of Pediatric Surgery, Doktorlar Cad, Denizli, Turkey
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Keh SM, Onyekwelu N, McManus K, McGuigan J. Corrosive injury to upper gastrointestinal tract: Still a major surgical dilemma. World J Gastroenterol 2006; 12:5223-8. [PMID: 16937538 PMCID: PMC4088025 DOI: 10.3748/wjg.v12.i32.5223] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In the developed and developing countries, corrosive injury to the gastrointestinal system as a consequence of either accidental ingestion or as a result of self-harm has become a less common phenomenon compared to decades ago. This could partly be attributed to the tighter legislation imposed by the government in these countries on detergents and other corrosive products and general public awareness. Most busy upper gastrointestinal surgical units in these countries, especially in the developed countries will only encounter a small number of cases per year. Up to date knowledge on the best management approach is lacking. In this article, we present our experience of two contrasting cases of corrosive injury to the upper gastrointestinal tract in our thoracic unit in the last 2 years and an up-to-date Medline literature search has been carried out to highlight the areas of controversies in the management of corrosive injuries of the upper gastrointestinal tract. We concluded that the main principle in managing such patients requires a good understanding of the pathophysiology of corrosive injury in order to plan both acute and future management. Each patient must be evaluated individually as the clinical picture varies widely. Signs and symptoms alone are an unreliable guide to injury.
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Affiliation(s)
- Siew Min Keh
- The Royal National Nose, Throat and Ear Hospital, London, WC1X 8DA, United Kingdom.
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Kayaalp L, Bozkurt P, Odabasi G, Dogangun B, Cavusoglu P, Bolat N, Bakan M. Psychological effects of repeated general anesthesia in children. Paediatr Anaesth 2006; 16:822-7. [PMID: 16884464 DOI: 10.1111/j.1460-9592.2006.01867.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although methods for reducing preoperative anxiety have been a major interest of pediatric anesthesiologists, there are no reports of the effects of repeated anesthesia on psychological development of children. METHODS To determine the overall effect of multiple anesthetics on the psychology of children, we undertook to compare the children undergoing repeated anesthesia (Group S) for the treatment of corrosive esophagitis with a control group (Group C) with chronic renal disease and frequent hospital admissions. Psychological tests and diagnosis of children Group S (n = 23) were compared prospectively with Group C (n = 20). All children had been appropriately treated over the previous 5 years and 50% of patients in Group C had general anesthesia once and those in Group S underwent at least 5 GAs. Parents completed a child behavior checklist (CBCL) and Marital Conflict Questionnaire; the children were evaluated by a child psychiatrist using DSM-IV criteria and completed the Child Depression Inventory (CDI). RESULTS The children in Group S underwent a total of 251 (11 +/- 7) GAs over 4-60 months. The incidence of psychopathology was nine and 10 children in groups S and C, respectively. The CBCL and CDI scores were parallel with a psychiatric diagnosis. Marital conflict scores were higher in Group S. CONCLUSIONS Both chronic disease states affect psychology of children. Repeated anesthesia in addition to chronic disease does not seem to disturb the child's psychological health further when tentative and precautious approach modalities are undertaken.
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Affiliation(s)
- Levent Kayaalp
- Department of Child and Adolescent Psychiatry, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
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Feng J, Gu W, Li M, Yuan J, Weng Y, Wei M, Zhou X. Rare causes of gastric outlet obstruction in children. Pediatr Surg Int 2005; 21:635-640. [PMID: 16041609 DOI: 10.1007/s00383-005-1472-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2005] [Indexed: 10/25/2022]
Abstract
Gastric outlet obstruction (GOO) presenting beyond the newborn period is a relatively rare condition, when infantile hypertrophic pyloric stenosis (IHPS) is excluded. This report describes the clinical features, evaluation and management of 18 patients with GOO which was not caused by IHPS. The sex, age, and main presenting features were recorded on admission. Hemoglobin estimation, serum chemistry and blood gas analysis were also assessed in these patients. The diagnosis was confirmed with gastrointestinal barium, B ultrasound, gastroscopy, or at surgery. Some of them underwent gastroscopy with biopsy sampling for rapid urease test or histologic examination with Giemsa stains for Helicobacter pylori. Thirteen patients had peptic ulcer disease, of which six were successfully treated with medications. While the other seven needed operative management which included Heineke-Mikulicz pyloroplasty, gastroduodenostomy or gastrojejunostomy, respectively. All the patients who had Heineke-Mikulicz pyloroplasty or gastrojejunostomy developed bile reflux gastritis that could be alleviated with omeprazol. None of the patients developed dumping syndrome, failing to thrive, or anemia. Three children with antral diaphragm recovered without any complications by diaphragm excision with Heineke-Mikulicz pyloroplasty. The pylorus was compressed by fibrotic band in one 30-month boy, and he recovered uneventfully with Heineke-Mikulicz pyloroplasty during 10-year follow-up. Gastric outlet obstruction secondary to ingestion of sulfuric acid was noted in one patient, and he was successfully treated with gastroduodenostomy. Our data suggests that the satisfactory results could be expected in children with GOO with different therapeutic modalities based on the specific cause and degree of obstruction.
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Affiliation(s)
- Jiexiong Feng
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Abstract
BACKGROUND/PURPOSE Gastric outlet obstruction (GOO) is a well-known complication of acid ingestion. However, most reports deal with adults. In this report, the authors present their experience with the treatment of acid-induced GOO in children. METHODS The records of patients admitted for unintentional ingestion of corrosive agents between 1980 and 2002 were reviewed retrospectively. Data concerning age at ingestion, type of ingested substance, time between ingestion and the first signs of GOO, weight loss, treatment, complications, duration of hospital stay, and long-term follow-up were reviewed. RESULTS GOO was not observed in any of the children admitted for alkaline ingestion, whereas GOO developed in 8 of 98 children (8.2%) in a mean period of 26.7 +/- 10 days after the ingestion of acid substances. Presenting symptoms were frequent nonbilious vomiting and marked weight loss. All had pyloric obstructions in the upper gastrointestinal series and required surgical intervention. Gastrojejunostomy was the operation of choice for all patients. Oral feedings were started on the third postoperative day. The complications were wound infection in 1 and upper gastrointestinal bleeding in another in the early postoperative period. Mean follow-up is 8.33 +/- 4.45 (4.8-18.7) years. No late complications such as marginal ulcus or stricture at the anastomosis site were observed in the series. CONCLUSIONS Treatment of GOO with gastrojejunostomy gives good long-term results in children. This procedure is safe and causes minimal morbidity particularly in patients without extensive gastric damage.
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Affiliation(s)
- Coşkun Ozcan
- Department of Pediatric Surgery, Ege University Faculty of Medicine, Izmir, Turkey
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Abstract
Gastric outlet obstruction is a common late result after acid ingestion; early complications, such as gastric necrosis or perforations are unusual. This is a report of a patient with the history of strong acid ingestion who underwent total gastrectomy due to perforation and extensive necrosis of the stomach.
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Affiliation(s)
- Feryal Gün
- Istanbul University, Istanbul Medical School, Department of Pediatric Surgery, Turkey.
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