Corrosive injuries of the stomach are not uncommon in developing countries, where accidental or suicidal ingestion of acids is encountered more often than in developed countries, where lye or alkaline corrosives are more frequent [1]. The most common occurrences are accidental ingestion, particularly in children, because of careless storage of chemicals, and ingestion with suicidal intent, because of the free availability of caustic agents.
The extent of esophageal and gastric involvement, by and large, depends on the nature of the corrosive ingested. Acids affect the stomach more commonly than alkalis do; they cause mucosal damage by coagulation necrosis, and they require a longer duration of contact [2, 3]. However, alkali damage of the stomach has also been reported [4, 5]. Acids are cleared rapidly from the esophagus to the stomach, where they pool in the prepyloric area in response to corrosive-induced pylorospasm [6–8]. Prolonged contact with the prepyloric mucosa results in a prepyloric stricture. Strictures can also occur in the antrum, the body, or the pyloroduodenal area. When the volume of the corrosive ingested is large, the entire stomach becomes scarred, leading to a diffusely contracted stomach. On the other hand, alkalis cause liquefaction necrosis, are more viscous, and tend to adhere to the esophageal mucosa with only a relatively small amount reaching the stomach. Thus the extent of esophageal damage is greater with alkalis than with acids [3].
Extensive acute injuries are usually fatal. Therefore the spectrum of acute and chronic gastric injury seen at a tertiary care referral hospital is not reflective of the overall picture, as patients with the most severe gastric and esophageal injuries die at peripheral centers.
This article presents a single-center experience of over 30 years in the management of 109 patients with chronic corrosive gastric injuries, emphasizing the spectrum of injuries, the extent of involvement, and highlighting the possible modes of management. We propose a classification scheme for chronic corrosive gastric injury to aid in surgical decision making.