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Delayed sequelae of hydrochloric acid ingestion.
C Wilasrusmee1, V Sirikulchayanonta, W Tirapanitch
1Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Summary
Hydrochloric acid ingestion, often from toilet bowl cleaners, can cause delayed gastric outlet obstruction. Early symptoms may be minimal, but long-term follow-up is crucial for patients experiencing vomiting and cachexia.
Area of Science:
- Gastroenterology
- Toxicology
Background:
- Hydrochloric acid is a common ingredient in toilet bowl cleaners.
- Abuse of hydrochloric acid via ingestion for suicidal attempts is a concern in Thailand.
Observation:
- Three cases of delayed gastric outlet obstruction following hydrochloric acid ingestion are presented.
- Initial symptoms were minimal, with delayed onset of vomiting and cachexia months after ingestion.
- Pylorus and antrum were the most common sites of injury.
Findings:
- Pathological findings included mucosal ulceration, submucosal fibrosis, muscularis mucosae thickening, and eosinophilic infiltrations.
- All three cases underwent gastrectomy with good outcomes and no postoperative complications.
- Unlike previous reports, preoperative jejunostomy was not required for these patients.
Implications:
- Physicians should be aware of potential delayed complications of hydrochloric acid ingestion.
- Long-term follow-up is essential, even with minimal initial symptoms.
- This case series highlights effective management without preoperative jejunostomy.