Corrosive Poisoning Gastric Outlet Obstruction Treated by Early Definitive Surgery

Corrosive injury is common amongst young adults attempting suicide. Apart from oesophageal burns, many have predominant gastric injuries. Resulting gastric strictures need surgery in majority. Common practice is to do feeding jejunostomy followed by definitive surgery after a few months. But it is challenging in poor patients to maintain tube feeding. In view of this, we looked into alternative safe early definitive approach. This study was done in the Department of Surgical Gastroenterology in Medical College Kolkata. Over the last 8 years (January 2009 to April 2017), consecutive 74 patients with corrosive gastric strictures were included. Extent of gastric cicatrisation was assessed by endoscopy and barium study. Nutrition was maintained by oral, naso-jejunal or feeding jejunostomy. Early definitive surgery was preferred. Patients’ follow-up was evaluated. Patients presented with vomiting, weight loss and dysphagia. Out of 74 patients, 30 had associated oesophageal strictures which were amenable to dilatation. Pre-pyloric short strictures were found in 52 (70.27%) patients. Surgical procedures included stricturoplasty for short strictures (70%) and gastrojejunostomy for more severe gastric cicatrisation. Seventy-five per cent of the patients had definitive surgery within 3 months of injury. Complications included mortality in 3 (4.05%) patients and wound dehiscence, pneumonitis and ileus. All patients gained weight within 6 to 8 weeks and doing well during follow-up. Management of corrosive gastric injury depends on the extent of gastric involvement, associated oesophageal strictures and general condition of the patient. In majority, early definitive surgery like stricturoplasty, avoiding gastric resection or bypass provides very satisfactory and physiological outcomes.