外科ジャーナル

Caustic Gastric Stenosis in Adults

Abstract

Eugen Târcoveanu, Cristian Lupașcu, Nicolae Dănilă, Alin Vasilescu, Felicia Crumpei and Costel Bradea

Introduction: Caustic gastric stenosis is relatively rare complications after voluntary or accidental ingestion of caustic substances.
Methods: They analyzed all the medical recordings of the patients operated in First Surgical Clinic, “St Spiridon” Emergency Hospital Iasi during 2004-2017 (6 cases - lot A) for caustic gastric stenosis presented comparatively with a lot of 46 patients with caustic gastric stenosis (lot B) operated in the same clinic between 1990 and 2003.
Results: The most frequently used substance was the caustic soda in group B and detartrant (surface cleaning product – a descaling agent) in group A. The most common site of stenosis was antral, prepyloric; this is explained by the prolonged contact of the caustic with this declivity area and by the spasm of the ankle muscles secondary to caustic action. In the period of establishment of esophageal and/or gastric stenosis, in all cases of group A, esophageal dilation with endoscopic pneumatic balloon probe was started early for both esophageal and gastric stenosis and in group B only in 19 cases. Surgical treatment depended on the extent of the corrosive lesions. In most cases, with limited antral stenosis, we performed distal gastrectomy with gastroduodenal anastomosis. In the combined lesions (esophageal and gastric stenosis) we preferred surgical interventions in two or three steps.
Conclusion: Associated gastric and esophageal lesions form a distinct subgroup that often requires complex surgical resolution through laborious procedures. It is advisable to perform endoscopic dilation procedures, both esophageal and pyloric lesions, before attempting surgical treatment. Postoperative morbidity and mortality decreased over the time, through a personalized, differentiated approach to each case, into a multidisciplinary team.