Ref Number = PITIKA-ASPR0397
Avyandita Meirizkia, Hasri Salwan, Achirul Bakri
OBJECTIVE: Sulfuric acid (H2SO4) produces a coagulation necrosis of the gastric mucosa and submucosa. The process may involve the entire thickness of the gastric wall, with subsequent ulceration and fibrosis. Esophageal mucosa is more resistant to acid agents, which on contrary tend to injure gastric walls, in particular antrum and pylorus. Endoscopic balloning dilatation is minimal complication procedure that frequently used as management of pyloric stricture but has higher reccurence rate about 45%. However pyloroplasty is also a very safe procedure that has lower reccurence rate about 5%-15%.
CASE: A 6-years-old boy came with chief complaint vomiting, weakness, and dehydration. One month before admission he accidentally drank about 2 spoonfuls sulfuric acid. He felt discomfort at abdomen and was brought to local hospital. He got antiemetic. One week before admission he had frequent episode of vomiting about quarter glass, 2-3 times a day. He also had problem with swallowing. He had rapid loss of body weight about 8 kg in a month. He came to ER with severe dehydration. We started rehydration and did endoscopy. We found erosive esophagitis about 1/3 distal of esophagus and obstruction of pylorus. We treated him PPI, sucralfate and liquid diet. After a month, we re-evaluated with endoscopy, found total obstruction of pylorus, erosive esophagitis, and gastritis erosive in corpus and anthrum. Because there’s no equipment for endoscopic balloning dilatation, we consulted the patient to Surgery Department and decided to get pyloroplasty. Vomiting stopped after surgery. In a month he regain 4 kgs. 
CONCLUSION: Pyloroplasty is a very safe operation with minimum morbidity and excellent long-term outcome. It could be option beside endoscopic balloning dilatation. It is needed to ensure correct labelling and safe packaging for corrosive agents like H2SO4.
Keywords: stricture pylorus, accidental sulfuric acid poisoning, pyloroplasty.
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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