Surgical Management Protocol For Corrosive Strictures of the Oesophagus and the Stomach.

Kannan, R R (2007) Surgical Management Protocol For Corrosive Strictures of the Oesophagus and the Stomach. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : The commonest cause of benign obstruction of oesophagus in Southern parts of India is corrosive strictures. The most vulnerable age groups are children less than five years who often ingest accidentally and adults who take with suicidal intention. In India, acid ingestion is more common nearly Seventy to Eighty percentage than alkali ingestion compared to west. The acid ingestion causes coagulation necrosis, which are seldom deep and alkali produces liquefaction necrosis. The late complications of corrosive burns of upper gastrointestinal tract are stricture and cancer. Effective surgical management is necessary in addition to medical treatment in those who fail to respond to them at appropriate times. This is a prospective study of twentynine cases in which surgical management protocol is designed for corrosive stricture of esophagus and stomach. Nutritional assessment and methods to improve nutritional status are discussed. The management of corrosive stricture oesophagus and stomach are best individualized and tailored according to mode of presentation at the time of onset of symptoms, organ (s) involved by stricture, organ of substitute available, mental state of the patient, facilities available and experience of the surgeon. Overall Twenty to forty percentage of patient with second and third degree injuries develop stricture and out of which Twenty five to Fifty percentage require surgery (Howel & Collegues) AIM : To study the surgical management of corrosive strictures of oesophagus and stomach. METHODS : This prospective study conducted in the Department of Surgical Gastroenterology, Madras Medical College & Government General Hospital Chennai from the period of 2004 to 2007. In this study, the age group commonly affected was between Twelve to Twenty years and commonly affected sex were males (M/F:1:0.7). CONCLUSION : The extensive studies on corrosive stricture in our patients have certain definite implications to suggest : •To get detailed patient’s history and relevant investigation and management done during acute phase. • To critically assess the patient’s nutritional status and extent of severity of corrosive injury. • To have Endoscopy and contrast study at early period and at periodic intervals. • Dilatation for the eligible appropriate cases. • To define where dilatation is effective. • To select right procedures and intervene at the appropriate time. • To improve the nutritional status by enteral and parenteral routes to withstand the surgical procedure. • Recently jejunal free flaps using micro vascular anastomosis have gained momentum when stomach, colon are not available. • To have adequate regular follow up. • To declare safety precautions in labeling & storing of corrosives agents. • To have strict ligislation to avoid sale of corrosive agents across the counter. • Last but not the least, psychiatric counselling to the patient and their relatives.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Surgical Management Protocol ; Corrosive Strictures ; Oesophagus ; Stomach.
Subjects: MEDICAL > Surgical Gastroenterology and Proctology
Depositing User: Kambaraman B
Date Deposited: 27 Jul 2017 03:38
Last Modified: 27 Jul 2017 03:38

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