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1/168. Delayed sequelae of hydrochloric acid ingestion.

    hydrochloric acid is the active ingredient in common toilet bowl cleaner agents used in thailand but it is occasionally abused for suicidal attempts by ingestion. Clinicopathological description caused by this agent has rarely been mentioned in the literature. We reported three cases of gastric outlet obstruction. Two of these cases were initially treated in provincial hospitals by gastric lavages. No clinical symptoms relating to ingestion and swallowing were present in the early period after ingestion but patients developed vomitting and cachexia a few months later. Among these three cases, pylorus and antrum were the most common sites of injury. All cases were gastrectomized and pathological findings of the resected specimens showed mucosal ulceration, submucosal fibrosis, thickening of muscularis mucosae, and eosinophilic infiltrations. Most cases in the literature had preoperative jejunostomy preformed but our cases did not have such a preoperative procedure. The outcomes of all cases were considered good and no postoperative complication was found. This presentation is aimed to stimulate physicians to be aware of delayed complications of hydrochloric acid ingestion and long term follow-up is required even though the initial symptoms of the patients were minimal.
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2/168. gastric outlet obstruction as a late complication of formaldehyde ingestion: a case report.

    A patient who ingested formaldehyde in a suicide attempt is described. Although early clinical and endoscopic manifestations appeared relatively mild, after several weeks the patient developed signs and symptoms suggestive of gastric outlet obstruction that eventually required surgical intervention. formaldehyde ingestion has only rarely been described in the literature. formaldehyde is a corrosive that can produce late sequelae, similar to the more common ingestion of acids and alkali.
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3/168. Percutaneous endoscopic duodenostomy: the relief of obstruction in advanced gastric carcinoma.

    nausea and vomiting in patients with advanced gastric malignancy and mechanical obstruction are distressing and difficult to manage. We describe a patient with linitis plastica and gastric stasis who was treated with a percutaneous endoscopic duodenostomy as the stomach could not be used for percutaneous endoscopic gastrostomy (PEG) formation. A Conflo PEG tube was inserted into the second part of the duodenum using the Ponsky-Gauderer technique without complication. The patient experienced excellent symptomatic relief and tolerated enteral nutrition extremely well, regaining some weight. This manoeuvre can produce effective symptom palliation allowing the patient to be managed at home during the terminal phase of their illness.
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4/168. The development of hypertrophic pyloric stenosis in a patient with prostaglandin-induced foveolar hyperplasia.

    BACKGROUND: Hypertrophic pyloric stenosis (HPS) has been described in association with several obstructive antropyloric lesions including idiopathic foveolar hyperplasia (gastric mucosal hypertrophy), feeding tubes, eosinophilic gastroenteritis, and hypertrophic antral polyps. Non obstructive antral webs have also been described with HPS. PATIENT AND methods: We present a case of gastric-outlet obstruction in association with HPS, namely, prostaglandin-induced foveolar hyperplasia. This entity has been previously described, but rarely in association with HPS. We report a female infant requiring prostaglandin therapy for pulmonary atresia who developed dose-related prostaglandin-induced foveolar hyperplasia and symptoms of progressive non-bilious vomiting. RESULTS: Initially, ultrasonography demonstrated evidence of antral mucosal hypertrophy as the cause for gastric-outlet obstruction. The patient subsequently developed progressive thickening of the antropyloric muscle, resulting in sonographic appearances of hypertrophic pyloric stenosis. Pyloromyotomy was eventually required for treatment of HPS. CONCLUSION: A common denominator of most of the above-described entities is thickening and/or hypertrophy of the antral mucosa. We suggest that the antropyloric musculature may hypertrophy in an effort to overcome the gastric-outlet obstruction caused by the adjacent thickened antral mucosa. In other words, these entities may represent examples of "secondary" hypertrophic pyloric stenosis.
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keywords = obstruction
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5/168. Primary hypertrophic tuberculosis of the pyloroduodenal area: report of 2 cases.

    tuberculosis of the stomach and duodenum is rare in patients with pulmonary tuberculosis. Primary involvement is even rarer. Two cases of primary tuberculosis of the localised to the pyloro-duodenal area are presented. The most common symptoms are non-specific leading to a difficulty in establishing a pre-operative diagnosis. A high degree of suspicion is therefore required for its diagnosis and to differentiate it from more frequent causes of gastric outlet obstruction such as chronic peptic ulcer disease and gastric carcinoma. The treatment of gastric tuberculosis is primarily medical with anti-tuberculous drug therapy. The role of surgery lies in the cases with obstruction following hypertrophic tuberculosis. The surgery done is usually a gastroenterostomy. With the relative rate of extra-pulmonary tuberculosis increasing, tuberculosis of the pyloro-duodenal area should be considered in the differential diagnosis of gastric outlet obstruction.
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6/168. Duplication cyst of the pylorus--a rare cause of gastric outlet obstruction in the newborn.

    Duplication cysts of the pylorus are the rarest of alimentary tract duplications with very few reported cases. We present such a cyst in a neonate presenting with gastric outlet obstruction. We have also reviewed the literature and outlined the theories of origin, modes of presentation, diagnosis and the surgical procedures. Even though several modes of surgery have been described, it is best to individualize the surgical option in each case. The results depend on the nature and site of duplication, complications and the associated anomalies.
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keywords = obstruction
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7/168. gastric outlet obstruction by a gallstone (Bouveret's syndrome).

    gastric outlet obstruction caused by a gallstone in the duodenum or pylorus(Bouveret's syndrome) is a very rare complication of gallstone disease. Presenting symptoms include epigastric pain, nausea, and vomiting. Preoperative diagnosis is not easy. Oral endoscopy is one of the diagnostic procedures. We present a case in which the diagnosis was made by endoscopic examination. Multiple attempts at endoscopic extraction of the gallstone from the duodenum were unsuccessful. A one-stage surgical procedure consisting of the removal of the impacted stone, fistula repair, and cholecystectomy was performed in this case. The postoperative course was uneventful.
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keywords = obstruction
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8/168. Duodenal perforation by a Wallstent.

    Endoscopic and/or radiological insertion of metallic mesh stents has recently been described as an alternative to palliative bypass operation in patients with gastric outlet obstruction caused by advanced malignant disease. We report a complication caused by migration and late perforation of the duodenum by a Wallstent, which raised concerns about the place of this procedure as an alternative to surgical bypass. The Wallstents have sharp ends and could cause ulcers or perforation of the viscus. Modification of the current Wallstent design may be needed.
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9/168. Duodenal web causing gastric outlet obstruction in an adult.

    Congenital duodenal web is a rare cause of gastric outlet obstruction in the adult. In this communication, we report a case in whom a preoperative diagnosis of chronic duodenal ulcer had been made. A review of diagnosis was forced by the finding of a normal pylorus at surgery.
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keywords = obstruction
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10/168. Antral web--a rare cause of vomiting in children.

    Antral web is a rare cause of gastric-outlet obstruction. We report a case of gastric antral web with intermittent vomiting in a 10-year-old girl who received medical treatment for 6 months. The literature on this anomaly is reviewed with respect to differential diagnosis on the basis of upper gastrointestinal radiographic series, gastroscopy, and treatment planning.
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