Case Of Gastric Outlet Obstruction Research Articles

Gastric outlet obstruction by Brunner's gland hyperplasia in an 8-year-old child

Several cases of Brunner's gland hyperplasia causing hemorrhage, obstruction, or intussusception have been published in the adult literature. Similar cases in the pediatric population are very rare and have only been described twice, always associated with chronic renal failure. We report the third and youngest case of gastric outlet obstruction because of Brunner's gland hyperplasia focusing on histopathologic condition and treatment based on a review of the literature.

Gastric outlet obstruction possibly secondary to ulceration in a 2-year-old girl: a case report

Gastric outlet obstruction due to ulceration is extremely rare in childhood. We report a case of gastric outlet obstruction possibly secondary to peptic ulceration and our surgical management. Our approach, without vagotomy or antrectomy, would appear to be a safe and effective.

Successful Endoscopic and Medical Management of a PYLORIC Channel Stenosis in a Patient with Metastatic Gastrinoma and Multiple Gastric Carcinoid Tumors

Purpose: To describe a case of gastric outlet obstruction and multiple carcinoid tumors in a patient with metastatic gastrinoma. Methods: A 58 year old man with past medical history significant for multiple endocrine neoplasia type 1 who had a pancreatic tail resection 25 years ago for a gastrinoma presented to our hospital with intractable nausea and vomiting. Two months prior to his current admission, a EGD done for workup of anemia showed diffuse nodularity (Image 1) involving the body and fundus of the stomach with antral sparing as well as smaller nodules in the duodenal bulb and 2nd portion of the duodenum. Gastric pH was 6 on proton pump inhibitor therapy. Multiple biopsies of the gastric nodules exhibited well differentiated neuroendocrine tumors in the setting of foveolar gland hyperplasia; duodenal and antral biopsies revealed metastatic gastrinoma. Results: Two month later, he returned with intractable nausea and vomiting. A repeat EGD showed nodules that were partially obstructing the pylorus as well as a high grade non-transversable stenosis of the pylorus. Gastric pH was 7. Incremental balloon dilation to 20 mm was then performed resulting in decreased resistance to scope passage. Antral biopsies from the procedure were positive for H. Pylori for which he received treatment. Two months following the procedure, the patient has had no recurrence of nausea and vomiting is tolerating a full diet. Conclusion: Carcinoid tumors arise from enterochromaffin-like cells in oxyntic glands of the stomach, of which gastrin is a potent stimulant. The antrum is relatively void of these glands, which explains the antral sparring of carcinoid tumors on endoscopy in our patient. The dramatic nodular appearance on endoscopy likely represents carcinoid tumors and foveolar hypertrophy accompanied by areas of glandular atrophy due to chronic H. pylori infection. We have two potential explanations why our patient would have developed a gastric outlet obstruction after several years on proton pump inhibitor therapy. First, active H. pylori infection may have caused significant acute edema in the setting of chronic fibrosis. In addition, partially obstructing metastatic gastrinoma nodules deforming the prepyloric area may have contributed to the obstruction.Figure

Gastric outlet obstruction caused by heterotopic pancreas: A case report and a quick review

A 46-year-old Chinese woman presented with nausea, recurrent vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor at the prepyloric area on the posterior wall of the stomach. A degenerated gastrointestinal stromal tumor was suspected. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas (HPs) was confirmed. The patient had an uneventful postoperative course and was discharged 7 d after operation. The patient remains healthy and symptom-free in the follow-up of 6 mo. This is a report of a case of gastric outlet obstruction resulting from pancreatic heterotopia in the gastric antrum in an adult woman.

Gossypiboma: An Unusual Cause of Gastric Outlet Obstruction Diagnosed by Endoscopy

Purpose: A gossypiboma, or retained surgical sponge is an uncommon surgical complication. Imaging plays a vital role in identifying retained foreign objects. To the best of our knowledge, it has been been rarely reported for gossypiboma to cause gastric outlet obstruction. We are reporting a case of gastric outlet obstruction caused by gossypiboma and diagnosed primarily by upper GI endoscopy. Results: A 40-year-old man presented with upper abdominal pain and persistent vomiting for three days prior to admission. The pain was epigastric, non radiating and without any aggravating or relieving factors. He denied history of weight loss, melena or hemetemesis. He had a past history of cholecystectomy done abroad 3 years ago. His general physical examination was unremarkable. Abdominal examination revealed a healed right subcostal scar of open cholecystectomy. On palpation, there was an intra-abdominal firm mass in the right hypochondrium. His hemogram, biochemical parameters, chest x-ray films were normal. After informed consent and overnight fasting, an upper GI endoscopy revealed stomach partially filled with fluids and food particles. Examination was not completed because of fear of aspiration. On repeat endoscopy after a longer fasting period, a fixed foreign body in the antrum obstructing the pylorus was seen. The foreign body had an appearance of woven fiber; a few fibers were removed using biopsy forceps, which suggested a surgical sponge. A contrast-enhanced CT scan of the abdomen revealed a foreign body with radiopaque segment in the proximal duodenum and pylorus with local peritonitis causing gastric outlet obstruction and hyperdistension of the stomach with some free fluid in the pelvis. There was no free air seen. The patient underwent surgical exploration, which confirmed the diagnosis. The sponge was removed, and the fistulous communication was repaired. Conclusion: Although gossypiboma is rarely seen in routine clinical practice, it should be considered in the differential diagnosis of acute mechanical gastrointestinal obstruction in patients who underwent laparotomy in the past. Early recognition of this condition may prompt appropriate investigation and treatment which may reduce morbidity and mortality. The best known approach in the prevention of this condition is meticulous counting of radiopaque surgical material in addition to a thorough evaluation of surgical site at the end of operation.

Gastric outlet obstruction without esophageal involvement: A late sequelae of acid ingestion in children

Accidental corrosive ingestion is not a rare occurrence in children because of easy access to strong household cleansers. Gastric injury as a predominant finding following acid ingestion in pediatric age group is less widely known with a few cases being reported in Indian literature. We report two such cases of gastric outlet obstruction following accidental ingestion of dilute acid. Both children have typical clinical presentation just 4-6 weeks after the ingestion. Upper GI endoscopy and barium meal studies confirmed the diagnosis. Early surgical intervention resulted in a satisfactory recovery. Both patients are doing well on follow up.

An Unusual Case of Metastatic Gastric Adenocarcinoma in a 19-yr-Old with Gastric Outlet Obstruction Safely Managed by Tandem Enteral Wallstents with Excellent Outcome

A 19-year-old girl was referred by her pediatrician for post prandial vomiting and a weight loss of 11lbs over one month. On examination a 10 cm X 10 cm firm mass was felt in the epigastrium which was very tender. Laboratory data showed hematocrit of 29 and CA 125 of 65.4 (normal 35). CT abdomen had shown thickening of mid to distal stomach, with surrounding fat infiltration, peri-gastric lymph nodes, thickening of transverse colon and pelvic ascites. On EGD a thickened, nodular and infiltrated appearing stomach with narrowed antrum and near complete obstruction of the pylorus was seen. Endoscopic biopsies were inconclusive. An upper GI series revealed a 13 cm long stricture extending from the distal stomach to the duodenum. EUS showed thickening of stomach wall consistent with linnitis plastica, but FNA samples were inconclusive. On surgical exploration a large intramural mass in the distal stomach was noted along with omental lesions above the transverse colon, peritoneal implants on the fallopian tubes, and ascites. Pathology revealed a poorly differentiated gastric adenocarcinoma with abundant mucin or signet ring cell carcinoma. As the tumor was unresectable, a decision was made to bypass the gastric outlet obstruction with enteral stents. Two Wallstents (Microvasive) enteral endoprostheses measuring 90mm and 60mm in length were placed, in a tandem fashion with partial internal overlap to bypass the stricture. Patient was discharged home on a liquid and puree diet. Chemotherapy with 5-Flurouracil, Cisplatin and Tamoxifen was given as an outpatient. At a 20 week follow up, patient has good oral intake with weight gain. Outpatient follow up barium studies and CT scans have shown patent stents with good flow of dye. (figure 1)FigureGastric adenocarcinoma in young patients can present as advanced disease with metastasis and gastric outlet obstruction. Here we report one of the first cases of gastric outlet obstruction from metastatic gastric adenocarcinoma in a young patient managed with Wallstent showing feasibility, safety, and good long term patency.[figure 1]

Minimally Invasive Management of Obstructive Gastroduodenal Tuberculosis

Pulmonary tuberculosis (TB) is prevalent in Western urban centers, especially among immunocompromised patients and immigrants. However, TB enteritis is a rare sequela, occurring in less than 1 per cent of this population. Tuberculosis may affect any portion of the gastrointestinal (GI) tract, and 85 per cent of cases manifest in the ileocecal region. However, the stomach and duodenum are involved in just 0.3-2.3% of TB cases that affect the gut. Gastric outlet obstruction due to TB has been traditionally treated by a surgical bypass operation, followed by anti-TB chemotherapy. In a recent review of 17 cases of TB-related gastric outlet obstruction, gastrojejunostomy or duodenojejunostomy was performed in all patients. We present a case of gastric outlet obstruction due to TB that was treated successfully with a minimally invasive approach, without the need for a gastric bypass.

Gastrointestinal Neurofibromatosis: An Unusual Cause of Gastric Outlet Obstruction

Neurofibromatosis type-1 (NF-1), also known as von Recklinghausen disease, is a common autosomal dominant condition occurring in approximately 1/3000 births. NF-1 is known to be associated with gastrointestinal neoplasms in 2-25 per cent of patients. We report the first case of gastric outlet obstruction with perforation caused by neurofibroma in a patient with NF-1. The literature is reviewed, examining 61 previously reported cases of noncarcinoid gastrointestinal (GI) neoplasms in patients with NF-1 for symptoms, location, and types of neoplasms. Neoplasms were located most often in the small intestine (72%). Neurofibromas, found in 52 per cent of patients, were the most frequently diagnosed benign neoplasms followed by leiomyomas (13%), ganglioneurofibromas (9.8%), and gastrointestinal stomal tumor (GIST) (6.5%). Adenocarcinoma was present in 23 per cent of patients. Patients with NF-1 and GI symptoms are at risk for gastrointestinal neoplasms from which symptomatic patients are likely to experience significant morbidity.

A Case of Gastric Outlet Obstruction Complicated by Peptic Ulcer Secondary to Non-Steroidal Anti-Inflammatory Drug (NSAID)

A Case of Gastric Outlet Obstruction Complicated by Peptic Ulcer Secondary to Non-Steroidal Anti-Inflammatory Drug (NSAID)

A bizarre cause of gastric outlet obstruction

Gastric outlet obstruction (GOO) is invariably consequent upon intrinsic gastroduodenal pathology. Ingested foreign bodies are rarely considered to be a cause of this condition. We report possibly the first case of GOO caused by metallic foreign bodies occluding the pyloro-duodenal junction.

Gastric outlet obstruction secondary to heterotopic pancreas in the antrum: Case report and review

Heterotopic (aberrant) pancreas, a rare entity, is defined as the presence of pancreatic tissue without anatomic and vascular continuity with the pancreas itself. It can occur anywhere in the GI tract. 1 Armstrong CP King PM Dixon JM Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. B J Surg. 1981; 68: 384-387 Crossref PubMed Scopus (181) Google Scholar In most cases heterotopic pancreas does not cause symptoms, 1 Armstrong CP King PM Dixon JM Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. B J Surg. 1981; 68: 384-387 Crossref PubMed Scopus (181) Google Scholar but it can occasionally present as dyspepsia, 1 Armstrong CP King PM Dixon JM Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. B J Surg. 1981; 68: 384-387 Crossref PubMed Scopus (181) Google Scholar ectopic pancreatitis, 2 Burke GW Binder SC Barron AM Dratch PL Ulmas J. Heterotopic pancreas: gastric outlet obstruction secondary to pancreatitis and pancreatic pseudocyst. Am J Gastroenterol. 1989; 84: 52-55 PubMed Google Scholar upper GI bleeding, 3 Covarelli P Cirocchi R Bellochi R Ricci P Morozzi B Nonno S et al. Upper digestive hemorrhage as a rare manifestation of ectopic pancreas with gastric localization. G Chir. 1997; 18: 97-100 PubMed Google Scholar and as an inflammatory abdominal mass. 4 Kaneda M Yano T Yamamoto T Suzuki T Fujimori K Itoh H et al. Ectopic pancreas in the stomach presenting as an inflammatory abdominal mass. Am J Gastroenterol. 1989; 84: 663-666 PubMed Google Scholar Rarely, heterotopic pancreas has been reported as the cause of gastric outlet obstruction. 5 Kreig EG. Heterotopic pancreatic tissue producing pyloric obstruction: a review and case Report. Ann Surg. 1941; 113: 364-370 Crossref PubMed Google Scholar , 6 DeBord JR Majarakis JD Nyhus LM. An unusual case of heterotopic pancreas of the stomach. Am J Surg. 1981; 141: 269-273 Abstract Full Text PDF PubMed Scopus (39) Google Scholar This is a report of a case of gastric outlet obstruction resulting from pancreatic heterotopia in the gastric antrum.

Gastroparesis as a cause of nausea and vomiting after high-dose chemotherapy and haemopoietic stem-cell transplantation

Nausea and vomiting in patients undergoing high-dose chemotherapy and stem-cell transplantation (SCT) is a formidable clinical challenge despite the use of potent antiemetics. Gastroparesis is recognised as a cause of unexplained vomiting, but has not been investigated in relation to high-dose chemotherapy and SCT. As there are effective prokinetic agents, such as erythromycin, finding gastroparesis in this population could have therapeutic implications. We reviewed our experience of gastroparesis among patients with nausea and vomiting after high-dose chemotherapy and SCT, over 3 years. 13 of 24 gastric emptying studies (GES) done in 22 patients showed delayed emptying. One patient with delayed emptying, who was found to have adrenal insufficiency, was excluded (table). No cases of gastricoutlet obstruction or viral infection were identified in 19 patients who underwent upper endoscopy. Of the 15 treated with intravenous erythromycin, the majority responded. No statistically significant association between either GES result or response to erythromycin and any clinical feature was found. Our review suggests that gastroparesis may be responsible for many instances of delayed-onset nausea and vomiting after high-dose chemotherapy and SCT, whether allogeneic or autologous. Interpretation of our study is limited by its retrospective design, small study population, and lack of controls. Intravenous erythromycin seemed to help these patients. As erythromycin was used only after failure of all other available antiemetic agents, we believe that the responses observed were related to its promotility effect. Our inability to show an association between an abnormal gastric emptying study and response to treatment with erythromycin was probably attributable to an insufficiently large sample size. Furthermore, correlation between symptom response and gastric emptying status is known to be highly variable. Gastroparesis may also be responsible for similar prolonged symptoms after conventional chemotherapy regimens. A prospective study is in progress to confirm this association and better characterise response to erythromycin.

Prenatal diagnosis of congenital gastric outlet obstruction

A case of gastric outlet obstruction diagnosed prenatally at 22 weeks' gestation is described. The differential diagnosis and the clinical management of this rare condition are discussed, and an updated literature review is presented.

Internal displacement of a gastrostomy button: An unusual case of gastric outlet obstruction

Gastric outlet obstruction caused by gastrostomy tube migration should not occur in patients who have gastrostomy buttons. This is the first reported case of gastric outlet obstruction caused by internal displacement of a gastrostomy button.

Gastric phytobezoar presenting as gastric outlet obstruction in a child after Sugiura operation for bleeding esophageal varices

A case of gastric outlet obstruction caused by persimmon phytobezoars in a 14-year-old boy who had undergone a Sugiura operation for bleeding esophageal varices 5 years before admission is reported. Although most gastric bezoars represent a complication of previous gastric surgery, the occurrence in childhood after a Sugiura operation has not been previously reported.

An unusual case of gastric outlet obstruction: H. Takehara, M. Hino, H. Chikaishi, et al. Pediatr Surg Internat 4:134–136, (February), 1989

An unusual case of gastric outlet obstruction: H. Takehara, M. Hino, H. Chikaishi, et al. Pediatr Surg Internat 4:134–136, (February), 1989

An unusual case of gastric outlet obstruction

An unusual case of gastric outlet obstruction due to hypertrophic pyloric stenosis associated with prepyloric ulceration is described. An upper gastrointestinal series showed a tumorous filling defect at the pylorus. Hypertrophy of the muscle layer and tumorous, elevated mucosa were found in the pylorus, and an ulceration was present in the elevated mucosa at surgery. The clinical course was uneventful after selective vagotomy and gastric antrectomy.

Ulceration and obstruction in an antiperistaltic jejunal segment of excessive length

A case of gastric outlet obstruction resulting from ulceration and stenosis in an interposed antiperistaltic ejunal segment for treatment of the dumping syndrome is cited. The antiperistaltic segment originally measured 15 cm in length which was unquestionably too long. During the long range follow-up period, stasis, ulceration, and stenosis of the segment occurred with resultant obstruction. This necessitated removal of the jejunal reversal segment and its replacement by a segment of shorter length. Extreme caution should be exercised when constructing a jejunal reversal segment for treatment of severe dumping symptoms and the segment should not exceed 8 to 10 cm in length.

Pneumatosis Cystoides Intestinalis - A Case Report

Pneumatosis Cystoides Intestinalis is a rare condition characterised by gas-filled cysts in the wall of the smallgut and sometimes in its mesentry. When the process is limited to the large intestine, the term pneumatosis coli is used . The exact cause of the condition is unknown but it may develop in diseases like peptic ulcer, ulcerative colitis, regional enteritis, chronic bronchitis etc. The condition is usually diagnosed incidentally during abdominal scanning or investigation for the primary disease. Presentation as a case of gastric outlet obstruction (proximal jejunal obstruction) as happened in this case, is rare. A young adult male cultivator presented as a case of gastric outlet obstruction due to suspected chronic duodenal ulcer ( a common complication of Peptic ulcer disease in our country ). Per-operatively, gas filled cysts in proximal jejunum with almost obliteration of the lumen of the intestine was detected and diagnosed as a case of pneumatosis cystoides intestinalis and was treated with resection and anastomosis of the affected portion of gut. The patient is in good health even 5 years after the operation and showed no signs of recurrence of the condition. DOI: 10.3329/jbcps.v27i1.4243 J Bangladesh Coll Phys Surg 2009; 27: 45-48