Abstract
IntroductionGastric outlet obstruction is a clinical syndrome caused by a variety of mechanical obstructions. Peptic ulcer disease used to be responsible for most gastric outlet obstruction, but in the last 40 years the prevalence of malignant tumors has risen significantly. Adhesive disease is an infrequent and insidious cause of mechanical gastric outlet obstruction.Case presentationWe report the case of a 78-year-old Caucasian man who had a clinical history of a right nephrectomy for malignancy three years earlier and who was admitted for a severe gastric outlet obstruction (score of 1) confirmed both by an upper endoscopy and by a fluoroscopic view after contrast injection. A computed tomography scan and a laparotomy, with omental biopsies, showed a peritoneal carcinomatosis with the development of abdominal adhesions that prompted an abnormal gastric rotation around the perpendicular axis of his antrum with a dislocation in the empty space of his right kidney. Symptoms disappeared after surgical bypass through a gastrojejunostomy.ConclusionsOur patient experienced a very rare complication characterized by the development of adhesions due to peritoneal carcinomatosis caused by a renal carcinoma treated with nephrectomy. These adhesions prompted an abnormal dislocation of his antrum, as an internal hernia, in the empty space of his right kidney.
Highlights
Gastric outlet obstruction is a clinical syndrome caused by a variety of mechanical obstructions
Our patient experienced a very rare complication characterized by the development of adhesions due to peritoneal carcinomatosis caused by a renal carcinoma treated with nephrectomy
These adhesions prompted an abnormal dislocation of his antrum, as an internal hernia, in the empty space of his right kidney
Summary
This report highlights the importance of regular outpatient visits in patients with a history of neoplasms, even if they have undergone surgery and especially if they have not been treated with chemotherapy. Particular attention should be paid to new obstructive symptoms as possible consequences of late post-surgical or unusual peritoneal metastatic complications
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