PostSulfuric, El Salvador Atlas of Gastrointestinal VideoEndoscopy. A Large Database of Images and Video Clips with Cases Reported.
El Salvador Atlas of Gastrointestinal VideoEndoscopy
A case of gastric cicatrization caused by ingestion of sulfuric acid This 22 year-old male, in an attempt to commit suicide, ingests a quarter of liter of sulfuric acid (battery acid). The patient was hospitalized in a public hospital, where they tried to practice an upper endoscopy, but for unknown reasons it could not be performed. 10 days after the incident, erroneously a surgeon placed a catheter to be used as a gastrostomy but was applied above of the stenosis of the antrum. One month after the ingestion, the patient was referred to us to perform an Endoscopic evaluation.

Video Endoscopic Sequence 1 of 19.

 A case of gastric cicatrization caused by ingestion of
 sulfuric acid.

 This 22 year-old male, in an attempt to commit suicide,
 ingests a quarter of liter of sulfuric acid (battery acid).

 The patient was hospitalized in a public hospital, where they
 tried to practice an upper endoscopy, but for unknown
 reasons it could not be performed. 10 days after the
 incident, erroneously a surgeon placed a catheter to be
 used as a gastrostomy but was applied above of the
 stenosis of the antrum.

 One month after the ingestion, the patient was referred to
 us to perform an Endoscopic evaluation.

 For more endoscopic details download the video clips by
 clicking on the endoscopic image.
 All endoscopic images shown in this Atlas contain a video
 clip. We recommend seeing the video clips in full screen
 mode.

This gastrostomy catheter for feeding was placed 10 days later to the ingestion of the sulfuric acid, nevertheless is observed that in spite of ten days of the ingestion of acid, the corrosive activity was active corroding in form of blisters the material of the catheter

Video Endoscopic Sequence 2 of 19.

 This gastrostomy catheter for “feeding” was placed 10
 days later to the ingestion of the sulfuric acid, nevertheless
 is observed that in spite of ten days of the ingestion of acid,
 the corrosive activity was active corroding in form of
 blisters the material of the catheter.

 
Balloon Dilator Dilation of Gastric outlet obstruction is being performed with a hydrostatic balloon. Causes gastric outlet obstruction more commonly because of cicatricial antral stenosis.

Video Endoscopic Sequence 3 of 19.

Balloon Dilator

Dilation of Gastric outlet obstruction is being performed with a hydrostatic balloon.

 Causes gastric outlet obstruction more commonly because
 of cicatricial antral stenosis.

 
Causes gastric outlet obstruction more commonly because of cicatricial antral stenosis. Sulfuric acid produces a coagulation necrosis of the gastric mucosa and submucosa, and the process may involve the entire thickness of the gastric wall, with subsequent ulceration and fibrosis.

Video Endoscopic Sequence 4 of 19.

 The Cicatricial Bands are observed.

 Causes gastric outlet obstruction more commonly because
 of cicatricial antral stenosis. Sulfuric acid produces a
 coagulation necrosis of the gastric mucosa and submucosa,
 and the process may involve the entire thickness of the
 gastric wall, with subsequent ulceration and fibrosis.

 
The duodenum is observed with normal mucosa. Acids produce 'coagulative necrosis' with eschar formation at the site of injury. These injuries result in segmental or extensive strictures involving the upper aero-digestive tract. Stomach is more likely to be injured by acids. Acid induce spasm of pyloric musculature, thereby prolonging the contact time with the stomach wall, and produce a variety of gastric deformities like prepyloric stenosis, antral stricture, hour-glass deformity, or contracted small capacity stomach. Injuries to both stomach and esophagus are common, as was seen in almost half of our patients.

Video Endoscopic Sequence 5 of 19.

The duodenum is observed with normal mucosa.

 Acids produce 'coagulative necrosis' with eschar formation
 at the site of injury. These injuries result in segmental or
 extensive strictures involving the upper aero-digestive
 tract. Stomach is more likely to be injured by acids. Acid
 induce spasm of pyloric musculature, thereby prolonging
 the contact time with the stomach wall, and produce
 avariety of gastric deformities like prepyloric stenosis,
 antral stricture, hour-glass deformity, or contracted small
 capacity stomach. Injuries to both stomach and esophagus
 are common, as was seen in almost half of our patients.
 
A marked antrum and cicatrizing stenosis. The extremely reduced diameter of the pyloric channel is observed , to the left is a hole that corresponds to where it was the gastrostomy catheter, this stenosis reappeared every three weeks, dilation was performed repeatedly.

Video Endoscopic Sequence 6 of 19.

  A marked antrum and cicatrizing stenosis

 The extremely reduced diameter of the piloric channel is
 observed , to the left is a hole that corresponds to where it
 was the gastrostomy catheter, this stenosis reappeared
 every three weeks, dilation was performed repeatedly.

 

 

 
The esophageal mucosa is resistant to damage, following the ingestion of corrosive acid.

Video Endoscopic Sequence 7 of 19.

 The esophageal mucosa is resistant to damage, following the ingestion of corrosive acid.
 

 
The pseudo tumor of the antrum due to the intense activity of inflammatory reaction. After multiple sessions of dilation as the stenosis reapers the role of ablative therapy of argon plasma coagulator was used repeatedly in as many as five session combined with hydrostatic balloon.

Video Endoscopic Sequence 8 of 19.

The pseudo tumor of the antrum due to the intense activity of inflammatory reaction.

 After multiple sessions of dilation as the stenosis reapers
 the role of ablative therapy of argon plasma coagulator
 was used repeatedly in as many as five session combined
 with hydrostatic balloon.
Status post Argon plasma Coagulator and dilation with hydrostatic balloon.

Video Endoscopic Sequence 9 of 19.

Status post Argon plasma Coagulator and dilation with hydrostatic balloon.
After several sessions of argon plasma coagulator, the antrum has seen ulcerated and excavated.

Video Endoscopic Sequence 10 of 19.

After several sessions of argon plasma coagulator, the antrum has been ulcerated and excavated.

 
However the stenosis reappeared every 3 weeks.

Video Endoscopic Sequence 11 of 19.

However the stenosis reappeared every 3 weeks.
Gastric cicatrization caused by ingestion of sulfuric acid. The fibrosis of the gastric wall with motility disturbances, and the diminution of acid and pepsin production from damage to the glandular elements

Video Endoscopic Sequence 12 of 19.

Gastric cicatrization caused by ingestion of
 sulfuric acid.

The fibrosis of the gastric wall with motility disturbances, and the diminution of acid and pepsin production from damage to the glandular elements.

 
After multiple sessions we managed to overcome the severe inflammation reaction that produced stenosis of the antrum, In spite of these maneuvers the narrowness reappeared .

Video Endoscopic Sequence 13 of 19.

 After multiple sessions we managed to overcome the
 severe inflammation reaction that produced stenosis of the
 antrum, In spite of these maneuvers the narrowness
 reappeared.

 
Intralesional steroids reduce inflammation of sulfuric acid burning. Gastric outlet obstruction is a well-recognized sequela of corrosive ingestion. Such patients are traditionally treated surgically.

Video Endoscopic Sequence 14 of 19.

Intralesional steroids reduce inflammation of sulfuric acid burning.

 Gastric outlet obstruction is a well-recognized sequela of
 corrosive ingestion. Such patients are traditionally treated
 surgically.

 
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Video Endoscopic Sequence 15 of 19.

 

 
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Video Endoscopic Sequence 16 of 19.
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Video Endoscopic Sequence 17 of 19.
Endoscopic balloon dilation combined with intralesional steroid may be an effective alternative to surgery in such patients.

Video Endoscopic Sequence 18 of 19.

 Endoscopic balloon dilation combined with intralesional
 steroid and APC may be an effective alternative to surgery
 in such patients.

 
Final status of the ablativa therapy and intralesional deposit steroids. After high doses of intralesional steroids was injected in the antrum, this inflammatory reaction was overcoming.Patient has been stable after one year of the last session

Video Endoscopic Sequence 19 of 19.

Final status of the ablativa therapy and intralesional steroids.

 After high doses of intralesional deposit steroids was
 injected in the antrum, this inflammatory reaction was
 overcoming.

Patient has been stable after one year of the last session.