Pyloric stricture after corrosive ingestion in children: an attempt to address the optimum management of this rarity

Abstract

Corrosive ingestion in pediatric population can have devastating consequences. Pyloric stricture which is a rarer complication has not been discussed in details in existing literature. Whereas the presentation is more or less similar, a “case specific” approach may be required for the best outcome. We analyzed our series of eight patients to formulate a suitable approach to its management. This was a prospective observational study in the department of Pediatric Surgery in a tertiary health care centre in central India. Eight (n=8) patients with corrosive injuries exclusive to the pyloric antrum were analyzed with respect to the corrosive ingested, symptomatology, nutritional status, investigation findings, surgery undertaken and follow up. Total number of patients in our study were eight. Male -7 and female-1, mean age of 6.8 years, ranging from 4 and 10 years, most common agent was acid, ingested accidentally. Period of development of gastric outlet obstruction was 23 days, range between 11 days and 33 days. Initially presented with odynophagia but later developed features of gastric outlet obstruction. Procedure performed were Heineke Mickulicz pyloroplasty and Billroth I gastroduodenostomy with FJ depending on the intra operative findings. No significant post operative complications were encountered on follow up, all the patients had improved general condition and gained adequate weight. No re do surgeries were performed. Corrosive injury of the UGI tract is not uncommon in children. Pyloric stricture as a complication is relatively rare. Parents may seek consultation late only after the child has lost reasonable amount of weight. UGI Endoscopy and UGI contrast study are indispensable to evaluate the severity of damage and formulate the optimum plan of surgery. Early surgical intervention gives excellent result. Both Pyloroplasty and Billroth I anastomosis are safe with low morbidity and excellent long term outcome.