Wilasrusmee C, Sirikulchayanonta V, Tirapanitch W
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 1999 Jun;82(6):628-31.
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.
盐酸是泰国常用马桶清洁剂中的活性成分，但偶尔会有人因吞服而将其滥用于自杀企图。文献中很少提及由这种制剂引起的临床病理描述。我们报告了3例胃出口梗阻病例。其中2例最初在省级医院接受洗胃治疗。摄入后早期没有出现与摄入和吞咽相关的临床症状，但患者在几个月后出现呕吐和恶病质。在这3例病例中，幽门和胃窦是最常见的损伤部位。所有病例均接受了胃切除术，切除标本的病理结果显示黏膜溃疡、黏膜下纤维化、黏膜肌层增厚和嗜酸性粒细胞浸润。文献中的大多数病例术前进行了空肠造口术，但我们的病例没有进行这种术前操作。所有病例的预后均被认为良好，未发现术后并发症。本报告旨在促使医生意识到盐酸摄入的延迟并发症，即使患者的初始症状轻微，也需要进行长期随访。
