Analysis of presentation, management and outcome of corrosive gastric strictures.

INTRODUCTION : Corrosive injuries to the stomach and oesophagus is one of the common condition in developing countries like India .It may result in major morbidity and mortality particularly in the younger age group. Corrosive poisons are those substances which corrode and destroy tissues through direct chemical action. They almost always act locally and have few systemic effects. Caustic poisonings can occur after ingestion of caustic substances, such as acids and alkalis. The most commonly abused substance among acids is hydrochloric acid. Alkali ingestion is more common in the western developed countries. In India, acid ingestion is the cause of corrosive oesophageal strictures in about 75% of patients. Accidental ingestion of acids and alkalis has been reported to be less common in western countries at present as the effective publicity and the enforcement of the law to ban the sale of strong acids and alkalis in the open market. Accidental ingestion is more common in children and drunken adults, due to careless storing of chemicals .Ingestion with suicidal intent is more common in India due to free availability of the caustic agents mostly used for toilet cleaning purposes. Post-corrosive injuries with different degrees of severity can occur along the entire oesophagus particularly in the middle and distal part, more precisely at the site of physiological narrowing. In the stomach, they can appear in the antrum and pylorus. Strictures isolated to the stomach due to acid or alkali is not an uncommon entity in our tertiary centre where lot of patients particularly corrosive injuries are referred. AIM : To find out the mean duration between corrosive consumption and development of the gastric stricture. To find out the common site of stricture in the stomach Whether isolated or combined with esophageal stricture. Type of surgical procedure in relation to site of stricture and outcome after the procedure and to formulate a new working classification which will help in deciding the type of surgery in patients with corrosive gastric stricture. CONCLUSION : Our study on corrosive gastric stricture have certain implications to suggest : Corrosive stricture can be isolated to stomach or associated with oesophageal stricture. The morbidity and mortality of gastric corrosive stricture can be significantly reduced by adequate preoperative nutritional optimisation and pre operative evaluation to asses the extent of injury. This new working Classification will help in deciding the surgical strategy to be adopted in the management of corrosive gastric stricture according to the site of the stricture. The long-term results, particularly in the relief of symptoms, weight gain and quality of life are better after surgical management of corrosive gastric stricture