sulfuric acid  gastric cicatrization
A case of gastric cicatrization caused by ingestion of

Video Endoscopic Sequence 1 of 23.

A case of gastric cicatrization caused by ingestion of sulfuric acid with gastric antral stenosis.

This 22 year-old male, in an attempt to commit suicide, ingests a quarter of liter of sulfuric acid (battery acid).

The patient was hospitalized in a public hospital, where they tried to practice an upper endoscopy, but for unknown reasons it could not be performed. 10 days after the incident, erroneously a surgeon placed a catheter to be used as a gastrostomy but was applied above of the stenosis of the antrum.

One month after the ingestion, the patient was referred to us to perform an Endoscopic evaluation.

Acid injury to the upper GI tract can occur due to accidental or intentional ingestion of caustic substances. We present a case of acid injury of the gastric antrum complicated by prepyloric stenosis, and illustrate the evolution and resolution of the injury with serial endoscopic images over a 3 year period.

For more endoscopic details download the video clips by clicking on the endoscopic image. All endoscopic images shown in this Atlas contain a video clip. We recommend seeing the video clips in full screen mode.

 

 

 

 

gastric cicatrization caused by ingestion of

Video Endoscopic Sequence 2 of 23.

Gastric antral stenosis: complication of acid ingestion.

This gastrostomy catheter for “feeding” was placed 10 days later to the ingestion of the sulfuric acid, nevertheless is observed that in spite of ten days of the ingestion of acid, the corrosive activity was active corroding in form of blisters the material of the catheter.

Caustic injury to the upper GI tract can occur due to accidental or intentional ingestion of caustic substances.

Balloon Dilator

Video Endoscopic Sequence 3 of 23.

Balloon Dilator

Dilation of Gastric outlet obstruction is being performed with a hydrostatic balloon.

Serial incremental dilatations of the stricture, from 12mm to 20 mm, with a controlled radial expansion (CRE) balloon were performed over 8 sessions.

 

The Cicatricial Bands are observed.

Video Endoscopic Sequence 4 of 23.

The Cicatricial Bands are observed.

Causes gastric outlet obstruction more commonly because of cicatricial antral stenosis. Sulfuric acid produces a coagulation necrosis of the gastric mucosa and submucosa, and the process may involve the entire thickness of the gastric wall, with subsequent ulceration and fibrosis.

 

The duodenum is observed with normal mucosa.

Video Endoscopic Sequence 5 of 23.

The duodenum is observed with normal mucosa.

Acids produce 'coagulative necrosis' with eschar formation at the site of injury. These injuries result in segmental or extensive strictures involving the upper aero-digestive tract. Stomach is more likely to be injured by acids. Acid induce spasm of pyloric musculature, thereby prolonging the contact time with the stomach wall, and produce avariety of gastric deformities like prepyloric stenosis, antral stricture, hour-glass deformity, or contracted small capacity stomach. Injuries to both stomach and esophagus are common, as was seen in almost half of our patients.

 

 

 

 

Severe pinhole stenosis at the site of injury.

Video Endoscopic Sequence 6 of 23.

Severe pinhole stenosis at the site of injury.

The extremely reduced diameter of the piloric channel is observed , to the left is a hole that corresponds to where it was the gastrostomy catheter, this stenosis reappeared every three weeks, dilation was performed repeatedly.

 

The esophageal mucosa is resistant to damage, following the ingestion of corrosive acid.

Video Endoscopic Sequence 7 of 23.

The esophageal mucosa is resistant to damage, following the ingestion of corrosive acid.

 

Gastric antral stenosis: complication of acid ingestion.

Video Endoscopic Sequence 8 of 23.

Gastric antral stenosis: complication of acid ingestion.

The pseudo tumor of the antrum due to the intense activity of inflammatory reaction.

After multiple sessions of dilation as the stenosis reapers the role of ablative therapy of argon plasma coagulator was used repeatedly in as many as five session combined with hydrostatic balloon.

 

Status post Argon plasma Coagulator therapy and dilation with hydrostatic balloon.

Video Endoscopic Sequence 9 of 23.

Status post Argon plasma Coagulator therapy and dilation with hydrostatic balloon.

 

Gastric antral stenosis: complication of acid ingestion.

Video Endoscopic Sequence 10 of 23.

Gastric antral stenosis: complication of acid ingestion.

Severe pinhole stenosis at the site of injury. The stenosis reappeared every 3 weeks.

 

Endoscopy of Gastric antral stenosis: complication of acid ingestion

Video Endoscopic Sequence 11 of 23.

After several sessions of argon plasma coagulator therapy, the antrum has been ulcerated and excavated.

 

Endoscopy of Gastric antral stenosis: complication of acid ingestion

Video Endoscopic Sequence 12 of 23.

Gastric cicatrization caused by ingestion of sulfuric acid.

The fibrosis of the gastric wall with motility disturbances, and the diminution of acid and pepsin production from damage to the glandular elements.

 

Antral narrowness reappeared

Video Endoscopic Sequence 13 of 23.

Antral narrowness reappeared

After multiple sessions we managed to overcome the severe inflammation reaction that produced stenosis of the antrum, In spite of these maneuvers the narrowness reappeared.

 

Intralesional steroids reduce inflammation of sulfuric acid burning.

Video Endoscopic Sequence 14 of 23.

Intralesional steroids reduce inflammation of sulfuric acid burning.

Gastric outlet obstruction is a well-recognized sequela of corrosive ingestion. Such patients are traditionally treated surgically.

 

Gastric antral stenosis: complication of acid ingestion.

Video Endoscopic Sequence 15 of 23.

Gastric antral stenosis: complication of acid ingestion.

 

Endoscopy sulfuric acid burning

Video Endoscopic Sequence 16 of 23.

Gastric antral stenosis: complication of acid ingestion.

 

Endoscopy Gastric antral stenosis: complication of acid ingestion

Video Endoscopic Sequence 17 of 23.

Gastric antral stenosis: complication of acid ingestion.

 

Endoscopy sulfuric acid burning

Video Endoscopic Sequence 18 of 23.

Gastric antral stenosis: complication of acid ingestion.

Endoscopic balloon dilation combined with intralesional steroid and APC may be an effective alternative to surgery in such patients.

 

Endoscopy sulfuric acid burning

Video Endoscopic Sequence 19 of 23.

Final status of the ablativa therapy and intralesional steroids.

After high doses of intralesional deposit steroids was injected in the antrum, this inflammatory reaction was overcoming.

Patient has been stable after one year of the last session.

 

Endoscopy sulfuric acid burning

Video Endoscopic Sequence 20 of 23.

A follow up endoscopy was performed after 3 years.

(Patient did not return until after 3 years)

 

Endoscopy sulfuric acid

Video Endoscopic Sequence 21 of 23.

A follow up endoscopy was performed after 3 years.

This case demonstrates the evolution of severe gastric antral injury due to acid ingest.

 

Endoscopy gastric acid burning

Video Endoscopic Sequence 22 of 23.

In cases of severe injury, vigilant clinical followup facilitates early endoscopic assessment and low-risk treatment before critical, potentially endoscopically refractory high-grade stenosis develops.

 

Video Endoscopic Sequence 23 of 23.

The pre pyloric area after 3 years.

 

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