Gastric outlet obstruction secondary to acid ingestion in children

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Toxicology

Background:

• Gastric outlet obstruction (GOO) is a known complication of corrosive agent ingestion.
• Most existing literature on acid-induced GOO focuses on adult populations.
• Pediatric cases of acid-induced GOO are less frequently reported, necessitating specific clinical insights.

Purpose of the Study:

• To present the authors' experience in managing acid-induced gastric outlet obstruction in children.
• To evaluate the efficacy and safety of surgical interventions for pediatric GOO.
• To analyze long-term outcomes following treatment for acid ingestion complications.

Main Methods:

• Retrospective review of patient records admitted for unintentional corrosive agent ingestion between 1980 and 2002.
• Data collected included age, ingested substance, time to GOO onset, weight loss, treatment details, complications, and follow-up duration.
• Analysis focused on children who developed GOO after acid ingestion.

Main Results:

• Eight out of 98 children (8.2%) developed GOO after acid ingestion, with symptoms appearing a mean of 26.7 days post-ingestion.
• All affected children presented with nonbilious vomiting, significant weight loss, and required surgical intervention for pyloric obstruction.
• Gastrojejunostomy was the preferred surgical method, with early oral feeding initiated on postoperative day 3. Early complications included wound infection and upper GI bleeding in one patient each.
• Mean follow-up of 8.33 years revealed no late complications like marginal ulcers or anastomotic strictures.

Conclusions:

• Surgical treatment of pediatric gastric outlet obstruction using gastrojejunostomy yields favorable long-term outcomes.
• The gastrojejunostomy procedure is safe and associated with minimal morbidity in children, especially when extensive gastric damage is absent.