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.