Trends in Clinical and Medical Sciences
Special issue: Indian Medical Research Views and Findings on Last 5 years (2023), pp. 245 – 249
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-imrv038
ISSN: 2791-0814 (online) 2791-0806 (Print)
DOI: 10.30538/psrp-tmcs2023.si-imrv038
Analysis of gastric strictures presentation and their surgical management outcome
Dr. Kunal Chinubhai Modi\(^{1}\), Dr. Mehulkumar K Vasaiya\(^{2}\), Dr. Khyati Shah\(^{3}\) and Dr. Pranav Rambhai Patel\(^{4,*}\)
\(^{1}\) Associate Professor, Department of General Surgery, GMERS Medical College, Himmatnagar, Gujarat.
\(^{2}\) Assistant Professor, Department of General Surgery, GMERS Medical College, Himmatnagar, Gujarat.
\(^{3}\) Assistant Professor, Department of General Surgery, GMERS Medical College, Himmatnagar, Gujarat.
\(^{4}\) Associate Professor, Department of General Surgery, GMERS Medical College, Himmatnagar, Gujarat.
Correspondence should be addressed to Dr. Pranav Rambhai Patel at drpranavbjmc@gmail.com
Copyright © 2023 Dr. Kunal Chinubhai Modi, Dr. Mehulkumar K Vasaiya, Dr. Khyati Shah and Dr. Pranav Rambhai Patel. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: April 22, 2023 – Accepted: May 25, 2023 – Published: May 26, 2023
Abstract
Background and Aim: Corrosive gastric strictures may require more frequent dilations compared to peptic ulcer-related strictures. Strictures occurring at the distal gastric site may necessitate sufficient dilatation to prevent obstructive symptoms, but this comes with an increased risk of perforation. The aim of the study was to determine the mean duration between corrosive consumption and the development of gastric stricture.
Material and Methods: The present study analyzed data collected from patients admitted to the surgical unit of Medical College & associated hospital following corrosive ingestion. Clinical data, including a history of difficulty in swallowing, cough with expectoration, difficulty in breathing, abdominal pain, abdominal distension, vomiting, and fever, were collected. Barium swallows were performed to assess and locate the stricture site in the stomach and assess the distal flow. Intraoperative findings of corrosive strictures and the nature of the performed surgery were analyzed. Barium meal studies were conducted for all patients to locate the level of stricture in the stomach, identify associated esophageal strictures, and detect coexisting trachea-esophageal fistulas.
Results: A total of 24 patients who met the inclusion and exclusion criteria were included in the study. Among the 24 patients, 6 had hyponatremia, 5 had type I strictures, 3 had type VII strictures, and 2 had type IV strictures with hyponatremia. Type I strictures were observed in 4 patients, 1 patient had type VII, and 1 patient each had other types of strictures with hypokalemia. Hypokalemia was present in 8 patients with type I strictures, 3 with type VII, and 1 each with type IIa, type IIb, type III, and type IV strictures. Arcade-preserving antrectomy was performed in 6 patients. One patient had type IIa corrosive gastric stricture and was managed with stricturoplasty. Two patients with type IIb corrosive gastric strictures were treated with Pylorus Preserving Antrectomy. Two patients had type III corrosive gastric strictures, and they underwent circumferential sleeve resection and gastro-gastrostomy.
Conclusion: Adequate preoperative nutritional optimization and evaluation to assess the extent of injury can significantly reduce the morbidity and mortality associated with gastric corrosive strictures.
Material and Methods: The present study analyzed data collected from patients admitted to the surgical unit of Medical College & associated hospital following corrosive ingestion. Clinical data, including a history of difficulty in swallowing, cough with expectoration, difficulty in breathing, abdominal pain, abdominal distension, vomiting, and fever, were collected. Barium swallows were performed to assess and locate the stricture site in the stomach and assess the distal flow. Intraoperative findings of corrosive strictures and the nature of the performed surgery were analyzed. Barium meal studies were conducted for all patients to locate the level of stricture in the stomach, identify associated esophageal strictures, and detect coexisting trachea-esophageal fistulas.
Results: A total of 24 patients who met the inclusion and exclusion criteria were included in the study. Among the 24 patients, 6 had hyponatremia, 5 had type I strictures, 3 had type VII strictures, and 2 had type IV strictures with hyponatremia. Type I strictures were observed in 4 patients, 1 patient had type VII, and 1 patient each had other types of strictures with hypokalemia. Hypokalemia was present in 8 patients with type I strictures, 3 with type VII, and 1 each with type IIa, type IIb, type III, and type IV strictures. Arcade-preserving antrectomy was performed in 6 patients. One patient had type IIa corrosive gastric stricture and was managed with stricturoplasty. Two patients with type IIb corrosive gastric strictures were treated with Pylorus Preserving Antrectomy. Two patients had type III corrosive gastric strictures, and they underwent circumferential sleeve resection and gastro-gastrostomy.
Conclusion: Adequate preoperative nutritional optimization and evaluation to assess the extent of injury can significantly reduce the morbidity and mortality associated with gastric corrosive strictures.
Keywords:
Gastric Strictures; Gastrostomy; Hyponatremia; Oesophagus.