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Jaboulay gastroduodenostomy for pyloric obstruction after corrosive ingestion

Article in Journal of Pediatric Surgery Case Reports · October 2020

DOI: 10.1016/j.epsc.2020.101672

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 Journal of Pediatric Surgery Case Reports 63 (2020) 101672

Contents lists available at ScienceDirect

Journal of Pediatric Surgery Case Reports

journal homepage: http://www.elsevier.com/locate/epsc

Jaboulay gastroduodenostomy for pyloric obstruction after

corrosive ingestion
Supangat a, *, Muhammad Yuda Nugraha b, Peter Lundqvist c
a
Division of Pediatric Surgery, Dr. Soebandi Regional Hospital-Faculty of Medicine, Jember University, East Java, Indonesia
b
Faculty of Medicine, Jember University, East Java, Indonesia
c
Swedish University of Agricultural Sciences, Sweden

A R T I C L E I N F O A B S T R A C T

Keywords: Strong acid accidental ingestion is a common case in rural society and children. The effect of strong acids may
Corrosive cause injuries of the gastrointestinal tract. We present a case obstruction in the distal part of gastric after
Obstruction accidental sulfuric acid ingestion in children. Sulfuric acid ingestion is potential in children since its commercial
Pyloric
product physical appearance looks like drink water. Then the patient was diagnosed with pyloric obstruction
after barium meal examination and was treated using Jaboulay gastroduodenostomy procedure.

1. Introduction During surgery, there was obtained a total obstruction of pylorus

with sclerotic images along 2 cm with passage to the distal. We used
Accidental or intentional ingestion of corrosive agents is very com­ Jaboulay gastroduedenostomy shunting to treat the total obstruction.
mon in rural society. Strong acids are commonly presented as household This procedure makes a shunt between side of the distal part of gastric
materials. Strong acid accidental ingestion is more common in children into the side of duodenum. (Fig. 2). There was uneventful during post-
than adults. The common effect of strong acids may cause injuries in the operative recovery and the patient was discharged in the several days
distal part of the esophagus and stomach [1,2]. Obstruction in distal part after surgery.
of gastric that is caused by corrosive ingestion is very rare, approxi­
mately as little as 3.8% of all the cases of corrosive ingestion, as reported 3. Discussion
in literature [3]. We present a case obstruction in distal part of gastric
after corrosive ingestion in children and unusual procedure to treat Strong acid accidental ingestion commonly happens in developing
pyloric obstruction. countries. Most accidental ingestion of strong acid is experienced in
children [4]. In this case, the patient is still 7 years old that did acci­
2. Case report dental ingestion of sulfuric acid or hydrogen sulphate (H2SO4). H2SO4,
well known as accu water, is common household material as electronic
A 7 years old male patient was admitted to emergency department supporting device. The accidental ingestion of H2SO4 is potential in
after getting multiple episodes of vomiting several hours after having children since its physical appearance is looks like drink water (Fig. 2).
meals. The vomitus consisted of only the food contents. There was no Strong acid is corrosive agent that leads a coagulation necrosis of the
any difficulty in swallowing solids or liquids. He had history of hydrogen tissue. Then the necrosis tissue will form a tissue scars at the site of
sulphate (accu water) ingestion 30 days earlier. On abdominal exami­ injury which further leads to segmental or extensive stricture formation
nation there was gastric distension and no peristaltic sound during [5]. The degree of tissue injury is determined by concentration, amount,
auscultation. Based on anamnesis and examination findings, there was duration of contact, and presence of food in the stomach [6]. Large
obstruction in the distal of gastric. Further examination, we did amount of strong acid may induce perforation of empty stomach within
abdominal radiography examination of whole abdomen. Based on 24–48 hours. The mostly affected structure of the empty stomach is
barium meal examination, there was total obstruction in pylorus region pylorus. Strong acidt will induce gastric muscle spasm that increase of
(Fig. 1). acid volume in the pyloric region. Long duration contact of acid to the

* Corresponding author. Tel.: +62 0331 377877

E-mail addresses: [email protected] (Supangat), [email protected] (M.Y. Nugraha), [email protected] (P. Lundqvist).

https://doi.org/10.1016/j.epsc.2020.101672
Received 11 September 2020; Received in revised form 24 September 2020; Accepted 2 October 2020
Available online 5 October 2020
2213-5766/© 2020 Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Supangat et al. Journal of Pediatric Surgery Case Reports 63 (2020) 101672

Fig. 1. Abdominal radiography examination.

Fig. 2. A. Accu water (H2SO4), B. Drink water.

pyloric mucous will induce progressive tissue inflammation that indi­ The main acute symptom of pyloric obstruction is vomiting in 2–3
rectly will cause pyloric obstruction. The pyloric obstruction will appear hours after taking food. The untreated vomiting may presents dehy­
commonly 4–6 weeks after ingestion [7]. In this case, the pyloric drated and low electrolyte level. While chronic obstruction may induce
obstruction occurred 30 days after ingestion. malnutrition and weight loss [8]. In this case, the patient was admitted

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Supangat et al. Journal of Pediatric Surgery Case Reports 63 (2020) 101672

Fig. 3. Jaboulay gastroduodenostomy procedure.

to emergency department after getting multiple episodes of vomiting Funding

several hours after having meals. There was no dehydration condition.
The initial treatment of strong acid ingestion usually can be done by No funding or grant support.
conservative treatment. The principle of treatment is to maintain the
acidity in the stomach and keep the patient from dehydration. Conser­ Authorship
vative management usually uses supportive treatment likes proton
pump inhibitor (PPI) and intravenous fluids therapy. Then patient All authors attest that they meet the current ICMJE criteria for
should be observed for any development features of esophageal stricture Authorship.
or gastric outlet obstruction. The main choice observation for making
the diagnosis is upper gastrointestinal endoscopy, while in the rural Declaration of competing interest
hospital can be used barium meal or contrast CT scan of abdomen [9].
Gastric outlet obstruction like pyloric obstruction feature should be The authors declare that they have no known competing financial
treated by definitive surgery. The types of surgery which can be done are interests or personal relationships that could have appeared to influence
pyloroplasty, gastrojejunostomy and gastroduodenostomy surgery. But the work reported in this paper.
it depends upon the condition of patient, findings at laparotomy as well
as surgeon’s ability and judgment [10]. In this case, the patient came to Acknowledgements
emergency department after obstruction sign was appeared. After
radiography examination, the patient was treated with Jaboulay gas­ There is no acknowledgement in this article.
troduodenostomy procedure (Fig. 3). This procedure has low risk
complication for distal gastric reconstruction due to the pyloric was not References
resected [11]. This procedure can be main choice for distal gastric
reconstruction. Then, the patient recovered well post-surgery with no [1] Kikendall JW. Caustic ingestion injuries. Gastroenterol Clin N Am 1991;20:847–57.
[2] Hugh TB, Kelly MD. Corrosive ingestion and the surgeon. J Am Coll Surg 1999;189:
complication (Fig. 3). 508–22.
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4. Conclusion due to corrosive ingestion: incidence and outcome. Pediatr Surg Int 1999;15:
88–91.
[4] Hall AH, Jacquemin D, Henny D, Mathieu L, Josset P, Meyer B. Corrosive
Strong acid ingestion sequelae can be featured as pyloric obstruction substances ingestion: a review. Crit Rev Toxicol 2019;49(8):637–69.
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gical procedure of pyloric obstruction treatment with very few compli­ the Indian experience. Natl Med J India 2013;26:31–6.
[7] Hsu CP, Chen CY, Hsu NY, Hsia JY. Surgical treatment and its longterm result for
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Patient consent esophageal involvement: report of 2 cases. Surgical Chronicles 2016;21:94–6.

An informed consent was obtained from patient’s parents for

publication.

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[9] Lowe JE, Graham DY, Boisaubin Jr EV, Lanza FL. Corrosive injury to stomach: the [11] Frantzides CT, Carlson MA. Laparoscopic jaboulay gastroduodenostomy for gastric
natural history and role of fibro optic endoscopy. Am J Surg 1979;137:803–6. outlet obstruction: a case report. J Laparoendosc Surg 1996;6(5):341–4.
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