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Azmat CE, Mahmood U, Talat N, Mirza MB, Rehman WU, Khalid R. Deer velvet powder-induced antral stricture mimicking infantile hypertrophic pyloric stenosis in a 3-month-old infant: a case report. Ann R Coll Surg Engl 2025. [PMID: 40272159 DOI: 10.1308/rcsann.2025.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2025] Open
Abstract
Antral stricture is a rare cause of gastric outlet obstruction in infants, typically linked to infantile hypertrophic pyloric stenosis (IHPS). We report a case of a 3-month-old male with a 1.5-month history of progressively worsening, nonbilious vomiting. Although initial imaging suggested IHPS, intraoperative findings revealed a sealed antral perforation with dense adhesions, leading to a distal gastrectomy with Billroth I reconstruction. A detailed retrospective history disclosed that the infant had been given deer velvet powder, suspected to have contributed to the perforation and subsequent stricture formation. This novel association highlights potential risks of unregulated supplement use in infants and underscores the need for further investigation.
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Affiliation(s)
- C E Azmat
- The Children Hospital and University of Child Health Sciences, Lahore, Pakistan
| | - U Mahmood
- The Children Hospital and University of Child Health Sciences, Lahore, Pakistan
| | - N Talat
- The Children Hospital and University of Child Health Sciences, Lahore, Pakistan
| | - M B Mirza
- The Children Hospital and University of Child Health Sciences, Lahore, Pakistan
| | - W U Rehman
- The Children Hospital and University of Child Health Sciences, Lahore, Pakistan
| | - R Khalid
- The Children Hospital and University of Child Health Sciences, Lahore, Pakistan
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Peña-Vélez R, Roldán-Montijo M, Imbett-Yepez S, Ramírez-Mayans J, Loredo-Mayer A, Montijo-Barrios E. Endoscopic Balloon Dilation of Gastric Stenosis secondary to Polyarteritis Nodosa and Arterial Thrombosis in an Adolescent. JPGN REPORTS 2022; 3:e198. [PMID: 37168903 PMCID: PMC10158308 DOI: 10.1097/pg9.0000000000000198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/13/2022] [Indexed: 05/13/2023]
Abstract
A 13-year-old female with polyarteritis nodosa underwent a partial gastrectomy for ischemic necrosis and gastric perforation following left gastric artery thrombosis. She later presented with vomiting, early satiety, weight loss, and severe malnutrition, when she was diagnosed with an occlusive gastric stricture. She successfully underwent repeated therapeutic endoscopic balloon dilations until the endpoint of 15-18 mm lumen was achieved without any complications, and her symptoms resolved.
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Affiliation(s)
- Rubén Peña-Vélez
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Mariana Roldán-Montijo
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sharon Imbett-Yepez
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jaime Ramírez-Mayans
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
- School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandro Loredo-Mayer
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
| | - Ericka Montijo-Barrios
- From the Department of Pediatric Gastroenterology and Nutrition, Instituto Nacional de Pediatría. Mexico City, Mexico
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Sarma MS, Tripathi PR, Arora S. Corrosive upper gastrointestinal strictures in children: Difficulties and dilemmas. World J Clin Pediatr 2021; 10:124-136. [PMID: 34868889 PMCID: PMC8603639 DOI: 10.5409/wjcp.v10.i6.124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/30/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
Children constitute 80% of all corrosive ingestion cases. The majority of this burden is contributed by developing countries. Accidental ingestion is common in younger children (< 5 years) while suicidal ingestion is more common in adolescents. The severity of injury depends on nature of corrosive (alkali or acid), pH, amount of ingestion and site of exposure. There are multiple doubts and dilemmas which exist in management of both acute ingestion and chronic complications. Acute ingestion leads to skin, respiratory tract or upper gastrointestinal damage which may range from trivial to life threatening complications. Esophagogastroduodenoscopy is an important early investigation to decide for further course of management. The use of steroids for prevention of stricture is a debatable issue. Upper gastrointestinal stricture is a common long-term sequelae of severe corrosive injury which usually develops after three weeks of ingestion. The cornerstone of management of esophageal strictures is endoscopic bougie or balloon dilatations. In case of resistant strictures, newer adjunctive therapies like intralesional steroids, mitomycin and stents can be utilized along with endoscopic dilatation. Surgery is the final resort for strictures resistant to endoscopic dilatations and adjunctive therapies. There is no consensus on best esophageal replacement conduit. Pyloric strictures require balloon dilatation , failure of which requires surgery. Patients with post-corrosive strictures should be kept in long term follow-up due to significantly increased risk of carcinoma. Despite all the endoscopic and surgical options available, management of corrosive stricture in children is a daunting task due to high chances of recurrence, perforation and complications related to poor nutrition and surgery.
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Affiliation(s)
- Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Parijat Ram Tripathi
- Department of Pediatric Gastroenterology, Ankura Hospsital for Women and Children, Hyderabad 500072, Telangana, India
| | - Sachin Arora
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
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Gunadi, Munandar MA, Fauzi AR, Simanjaya S, Damayanti W. Gastric stricture following corrosive agent ingestion: A case report. Int J Surg Case Rep 2020; 75:539-542. [PMID: 32994146 PMCID: PMC7567050 DOI: 10.1016/j.ijscr.2020.09.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gastric stricture due to corrosive ingestion is a rare cause of obstruction in the upper gastrointestinal tract in children. However, only a few reports highlight the management of the stricture of the gastric antrum and pylorus, i.e. gastric outlet obstruction (GOO) due to corrosive ingestion, particularly in children. PRESENTATION OF CASE We report a 1-year-old male who presented with chief complaints of upper abdominal pain and profuse vomiting after accidentally ingesting sulfuric acid one month prior. On physical examination, minimal epigastric distension was found. Endoscopic examination showed oesophagitis, erosive gastritis, multiple gastric ulcers and suspicion of pyloric stricture. We decided to perform an exploratory laparotomy and found severe strictures from the major curvature to the gastric pylorus. Subsequently, we conducted gastrojejunostomy and Braun anastomosis. The patient was discharged on the eighth postoperative day uneventfully. DISCUSSION Endoscopy is a reliable technique for assessing upper digestive tract mucous membranes after caustic agent ingestion because it helps in making a definitive diagnosis, especially to define the anatomic location and injury severity. The timing and type of surgery for GOO is controversial. We performed Braun anastomosis in addition to gastrojejunostomy because of several advantages over other surgical methods. CONCLUSION We recommend choosing an appropriate supporting examination to precisely diagnose gastric stricture due to corrosive ingestion. Gastojejunostomy and Braun anastomosis show a good outcome for gastric stricture due to corrosive ingestion, particularly in children.
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Affiliation(s)
- Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
| | - Mukhamad Arif Munandar
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Aditya Rifqi Fauzi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Susan Simanjaya
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
| | - Wahyu Damayanti
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
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Utilization of Gastric Conduit in the Management of Combined Corrosive Esophageal and Stomach Stricture. World J Surg 2017; 42:211-217. [DOI: 10.1007/s00268-017-4167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rafeey M, Ghojazadeh M, Sheikhi S, Vahedi L. Caustic Ingestion in Children: a Systematic Review and Meta-Analysis. J Caring Sci 2016; 5:251-265. [PMID: 27757390 PMCID: PMC5045959 DOI: 10.15171/jcs.2016.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 10/02/2015] [Indexed: 02/06/2023] Open
Abstract
Introduction: Caustic ingestion that occurs accidently is one of the most common problems in children. Methods: This systematic review has been performed by searching the databases including Science Direct, ProQuest, Google Scholar, and PubMed. A strategic search was performed with keywords including caustic, corrosive, ingestion, and children, and was limited to articles in English and Persian. Data were analyzed using Comprehensive Meta-Analysis2 and PASW Statistics 18. Results: We selected 64 articles regarding caustic ingestion with a total sample of 11,345 cases. The data analysis indicated a higher consumption in young boys (age range 2.78 (2.02) years (OR=0.53 with a 95% confidence interval of 0.49-0.57 (P=0.08)). The most common caustic substances were household cleaning agents, particularly bleaches and cleaners. Esophageal cancer and death were reported as well as digestive and respiratory complications. Invasive and expensive techniques are frequently used for diagnosis, treatment and follow up. Conclusion: The results demonstrated that although caustic ingestion is a serious problem among children, it is a preventable and manageable issue. Therefore, appropriate efforts by families, government, factories, health team and media should be made to handle adequately this matter.
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Affiliation(s)
- Mandana Rafeey
- Department of Pediatrics Gastroenterology, Medicine Faculty, Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Department of Physiology, Medicine Faculty, Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeede Sheikhi
- Clinical Librarian, Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Vahedi
- Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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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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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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Prasad A, Mukherjee KA, Kaur M, Ali M, Kaul S. Laparoscopic vagotomy with gastrojejunostomy for corrosive pyloric strictures. J Indian Assoc Pediatr Surg 2011; 16:34-35. [PMID: 21430850 PMCID: PMC3047776 DOI: 10.4103/0971-9261.74523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- A. Prasad
- Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - K. A. Mukherjee
- Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - M. Kaur
- Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - M. Ali
- Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - S. Kaul
- Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi, India
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