Modified peroral pyloromyotomy and placement of a covered stent for refractory gastric outlet obstruction following ingestion of sulfuric acid.

Abstract

A 15-year-old boy accidentally ingested a mouthful of sulfuric acid (160g/L). He presented 20 days later with complaints of postprandial epigastric distress, repeated nonbilious vomiting, and marked weight loss (about 15kg). Barium swallow and endoscopy revealed antropyloric narrowing (● Fig.1,● Fig.2). Endoscopic balloon dilation was performed, and the symptoms were relieved. However, 2 months later the symptoms recurred, and barium swallow again showed pyloric narrowing (● Fig.3). Following approval by the Ethics Committee of Provincial Hospital Affiliated to Shandong University and in accordance with the Declaration of Helsinki for Medical Research involving Human Subjects, modified peroral pyloromyotomy and placement of a covered stent were performedwith the patient under general anesthesia. Radial incisions were made from the antrum to the duodenal bulb, and the pyloromyotomy was performed using a HookKnife (KD-620LR, Olympus, Tokyo, Japan). An endoscopic transpyloric covered stent was then placed (20×100mm; Micro-Tech [Nanjing] Co., Ltd., Nanjing, China) (● Video 1). Two weeks after the operation, stent migration was noted. The stent was retrieved and the patient was healthy with no problems after feeding. However, 3 months after the operation, he returned to the clinic with recurrent vomiting. The Fig.1 Barium swallow revealed marked delay in passage of contrast through the pylorus.