Cause Of Gastric Obstruction Research Articles

Fatal gastric volvulus: forensic pathology considerations and postmortem CT findings

Gastric volvulus is a rare cause of gastric obstruction, due to the rotation of the stomach by more than 180°. It is a rare but life-threatening medical emergency that is considered difficult to diagnose at the initial clinical presentation. Forensic pathologists may be presented with gastric volvulus in several ways, for instance, as a cause of sudden and unexpected death or in the context of suspected clinical errors. The post-mortem examination of gastric volvulus may be challenging, due to the specific technical issues it presents and the various mechanisms by which volvulus may cause death. We therefore present five cases of gastric volvulus that in combination represent almost the entire spectrum of presentations and post-mortem findings, to discuss how gastric volvulus may come to the attention of a forensic pathologist, the approach and findings at post-mortem examination (including post-mortem CT), and the variety of mechanisms by which gastric volvulus may result in death.

Abdominal aortic aneurysm mimicking the cause of gastric obstruction.

A case of abdominal aortic aneurysm appeared to be compression of the antrum of the stomach and was suspected of causing a gastric obstruction. However, an upper gastrointestinal endoscopy to rule out an obstruction by a tumor revealed a gastric tumor, thus avoiding unnecessary intervention, such as open surgery.

Hypertrophic Pyloric Stenosis: 10 Years' Experience with Standard Open and Laparoscopic Approach.

PurposeHypertrophic pyloric stenosis (HPS) is the most common cause of gastric obstruction in newborns. Extra-mucosal pyloromyotomy can be performed through a small laparotomy or laparoscopy. The aim of this study was to compare the two surgical techniques. We also analyzed the incidence of HPS in infants in the last 10 years in relation to the demographic trend of our province.MethodsWe analyzed all the cases of HPS treated at our Unit between January 2010 and December 2019. The data were obtained from operating systems. Data about the demographic trends, in particular, the number of births and the population residing in the province of Verona from 2010 to 2019, were also retrieved.ResultsDuring the study period, 60 patients were treated for HPS and met the inclusion criteria. Of these, 56 males and 4 females with an average age of 38±14 days at surgery were included. No differences were found in terms of the duration of surgery, post-operative complications, duration of hospitalization, and weight at the time of surgery. The only statistically significant data was the chlorine level in cases with and without post-operative vomiting (97±3.5 vs. 102±3.3 mmol/L, p<0.05). There was a lower incidence of HPS from 2014 to 2019; however, there was no significant evidence regarding the correlation between this and the reduced birth rate recorded in the province of Verona during the same period.ConclusionAlthough laparoscopic pyloromyotomy is a highly complex procedure, it is a feasible alternative to the classic open technique.

Bouveret's syndrome and biliary ileus. An extremely rare cause of gastric obstruction

Blackground: Bouveret’s syndrome and biliary ileus, an extremely rare cause of gastric obstruction (about 300 cases published about Bouveret’s syndrome), is due to the impaction of a duodenal calculus secondary to a cholecystoduodenal or cholecystogastric fistula. It is associated with women, with more than 70 years old and large gallstones. The surgical treatment depends of the patient, the side of the calculus and its location. Surgical treatment is enterolithotomy with or without cholecystectomy. The fistula can close spontaneously so its repair may be unnecessary. The aim is to present two cases of biliary ileus and we do a bibliographic review to know its management. Material & Methods: The first patient was an 81 years old male who consulted in the emergency room for oral intolerance and vomiting. A CT study was performed, finding a cholecystoduodenal fistula and lithiasis that causes intestinal obstruction in the duodenum (figure 1). The other patient, was an 91 years old female who consulted in the emergency room for vomiting. In CT we could see a cholecystoduodenal fistula and a lithiasis in ileon that caused intestinal obstruction. Results: First patient underwent surgery with enterolithotomy. Six days after surgery, the patient was discharged home without symptoms. In the second case, the patient needed surgery with enterolithtomy, cholecystectomy and closure of the duodenum. In Conclusion: in these patients, intestinal obstruction must be treated first with an enterolithotomy and a biliary procedure, including cholecystectomy and biliary-enteric fistula closure, in low-risk patients.

Bouveret's syndrome and biliary ileus. An extremely rare cause of gastric obstruction

Bouveret's syndrome and biliary ileus. An extremely rare cause of gastric obstruction

A rare case of gastric outlet syndrome: internal incarceration after removal of gastric banding

The laparoscopically administrated adjustable gastric banding used to be widely practiced as treatment of extreme obesity. As lots of complaints and complications arose sooner or later after this procedure, they had to be removed quite often. Half year after such a removal we observed a 37-year-old female patient with complete gastric outlet obstruction. The patient was operated and cured completely. The cause of gastric obstruction was an internal incarceration of the pyloric region between the plication made at the time of the ring removal and the gastric body. We found no similar case of gastric outlet obstruction in the corresponding literature.

A Rare Presentation of Xanthogranulomatous Cholecystitis as Bouveret’s Syndrome

The purpose of this paper is to present sonographic and CT imaging findings of xanthogranulomatous cholecystitis (XGC) presented as Bouveret's syndrome, a very rare cause of gastric obstruction. While the patient's physical examination, upper GI endoscopy, and radiological findings all pointed to Bouveret's syndrome, CT differential diagnosis suggested either XGC or gallbladder carcinoma, and the final diagnosis was done histopathologically. Our paper aims to increase awareness in radiologically diagnosing XGC cases by introducing the possibility of existence of Bouveret's syndrome.

An atypical cause of intestinal occlusion and hidronephrosis

We present the case of a 56-year-old male with a history of psoriasis and occasional arthritis treated with NSAIDs and corticosteroids. Onset was days before admission, presenting poor general conditions, symmetrical arthritis (elbows, wrists and interphalangeal joints) and sustained fever of 38.5 oC accompanied by progressive dyspnea at rest, no cough, expectoration or chest pain. The exploration observed widespread psoriasis lesions, arthritis of the elbows and wrists, and hypoventilation of the base of the lungs, with rhythmic heart sounds and a pleural rub. Analytically, the patient presented hemoglobin of 11.3 g/dl, WBC 14.8×103/μl, neutrophils 13.3x103/μl, lymphocytes 1×103/μl, platelets 298×103/μl, prothrombin time 58%, activated partial thromboplastin time: 57.9 s, C-reactive protein > 9 mg/dl, ESR 83 mm/1st hour and cardiac enzymes within normal values. The electrocardiogram showed sinus rhythm at 100 beats per minute, with an axis at +30o, with no evidence of the repolarization abnormalities or signs of ischemia. The chest x-ray showed grade III/V cardiac enlargement and pleural effusion. The echocardiogram showed moderate pericardial effusion without signs of tamponade or segmental hypomotility. A chest scan was requested, which confirmed the existence of pleural and pericardial effusion (Figure 1). Suspecting sepsis of respiratory origin, empirical antibiotic therapy with ceftriaxone was begun. Blood urine and sputum cultures for bacteria and Koch bacilli were serially taken and resulted repeatedly negative. The patient had an unfavorable clinical course, with persistent fever and intestinal ileus presented as abdominal distension, diffuse pain on palpation and fecaloid vomiting, with a progressive increase of acute phase reactants. Abdominal scan were performed (Figure 2) and significant expansion of the intestine, from sigma to the stomach, was observed without an evident cause of gastric obstruction. The right kidney showed dilated caliceal groups, with grade III hydronephrosis and dilation of the initial portion of the ureter. The colonoscopy was not objective because of stenosis. Reumatol Clin. 2010;6(2):115–116

Annular pancreas - a rare cause of gastric obstruction in an 82-year-old patient

Annular pancreas - a rare cause of gastric obstruction in an 82-year-old patient

Annular pancreas – a rare cause of gastric obstruction in an 82-year-old patient

Annular pancreas is an uncommon and rarely reported congenital anomaly and thus is rarely suspected. A case is reported of an 82-year-old patient who presented with a 3-month history of nausea and vomiting associated with weight loss who at laparotomy was found to have an annular pancreas.

Diagnosis and Treatment of Gastric Motility Disorders

A disorder of gastric motility should be suspected in patients with chronic vomiting. Imaging studies are used to confirm delayed gastric emptying, the most common form of a gastric motility disorder. Other causes of chronic vomiting, for example, metabolic or endocrine disorders, other abdominal disorders, mechanical causes of gastric obstruction, and lower gastrointestinal tract disease, are then ruled out. If no underlying cause is determined, a functional disorder of gastric emptying is presumptively diagnosed. Treatment consists of dietary management and gastric prokinetic agents. Cisapride is the drug of choice for treating delayed gastric emptying followed by erythromycin and ranitidine or nizatidine.

Hypertrophic Pyloric Stenosis in the Adult

Hypertrophic pyloric stenosis in the adult as a cause of gastric obstruction has only recently obtained noticeable clinical recognition. Maier (7) noted the condition at autopsy; Maylard (8) directed attention to the importance of congenital stenosis of the pylorus in adults; more recent writers (2, 4, 10) have called attention to the surgical treatment, and Archer (1) and McClure (9) have lately contributed to knowledge of the roentgen aspects of the condition. The small number of cases described by various authors indicates the relative infrequency with which the condition is recognized. Pathology The essential pathology is a thickening of the musculature forming the pyloric sphincter, with resultant narrowing of the lumen. McClure (9) presents excellent illustrations of the gross and microscopic pathology. Etiology The etiology has not been definitely determined. Among the theories advanced are the following: 1. The persistence, through adult life, of a congenital hypertrophy of the pyloric muscle, insufficient to cause severe obstruction in infancy, but becoming aggravated in later years. Horton's (6) observation of the relative thickness of the pyloric muscle in the fifth and sixth months of fetal life is of interest. 2. Pirie's (11) theory is hyperadrenal ism, resultant deficiency in pancreatic secretion, with insufficient neutralization of gastric juices, consequent prolonged pyloric closure, and an eventual occurrence of pyloric hypertrophy and stenosis. Elman and Rowlette (5) suggest that gastric acidity is regulated by the pylorus, rather than that acidity regulates pyloric function. 3. Hypertrophy due to persistent pylorospasm from nervousness or reflex causes (1, 9). Symptomatology and Diagnosis The presence of a pyloric obstruction is to be suspected in all patients who give a history of epigastric pain relieved by vomiting long retained gastric contents. Among the conditions arising for differential consideration are: large esophageal diverticulum; malignancy or ulcer of the pylorus, with spasm; gastric syphilis or neurosyphilis with gastric crises; pylorospasm, without organic lesion; gastric or duodenal polypi; diverticulosis of the duodenum; duodenal ileus; chronic cholecystitis, with or without stones; pressure obstruction from pancreatic or other extrinsic tumors, and psychic vomiting. Roentgenologic examination of the gastro-intestinal tract and gall bladder obviously offers the best means of differentiating these various conditions. The chief roentgenologic findings (1) are essentially: 1. A persistent and unchanging increase in the width of the pyloroduodenal interval, “due to an increase in extent of the pyloric ring.” 2. The presence, in some cases, of associated spastic incisuræ several centimeters distant from the pylorus. 3. Failure of antispasmodics and fluoroscopic manipulation to alter the pyloric picture. 4. A narrow barium stream through the pylorus.