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Gastric outlet obstruction (GOO) is an uncommon disease. There is a mechanical obstruction to the outflow of stomach. The most common symptoms include nausea , vomiting, abdominal distension and pain, some patients may also complain of postprandial nausea and vomiting, early satiety, and weight loss. There are various causes that can lead to gastric outlet obstruction.
Gastric outlet obstruction is caused by benign or malignant mechanical obstruction or a motility disorder. Mechanical obstruction can be at the distal stomach, pyloric channel, or duodenum; and can be intrinsic or extrinsic to the stomach. Here we discuss a case of a young patient with gastric outlet obstruction due congenital band adhesion leading to obstruction and very rare phenomenon.
Patients with gastric outlet obstruction can have symptoms for a long period. They can remain undiagnosed until they start to suffer from severe weight loss. Here we discuss a case of a young middle aged female who has been suffering from inability to to eat solid food and rapid loss of weight. She was evaluated at multiple hospitals but proper diagnosis was not made and she was treated symptomatically. However by the time she presented to our Surgeon at MH Surgery Clinic she had severe weight loss and was nutritionally in a very poor condition.
She was seen and evaluated by our Surgical Gastroenterology Center. She underwent endoscopy, dynamic gastrograffin swallow study and a high resolution computed tomography. All the investigations were reviewed and our surgeons came to a diagnosis of a congenital band adhesion causing obstruction which is a rare form of gastric outlet obstruction. She required surgery. But as she was not eating much and was malnourished our Surgeons formulated a plan which included preoperative and postoperative nutritional support and surgery.
During the surgery, the stomach was distended and on careful evaluation, there was a scar or band that was causing obstruction. The area of the adhesion was a complicated area and required delicate surgery near the major blood vessels of the entire bowel. This was done very carefully fully preserving the blood flow and the obstruction was released. All this was performed by our surgeons at our MH Surgery Surgical Gastroenterology Center. The patient was managed in the high dependency care unit for few days with nutritional support. The patient recovered extremely well and remained well and was discharged home.
Gastric outlet obstruction has a variety of causes. Often primary care physicians are the first to encounter patients. A thorough workup to determine the cause of the obstruction must be performed that may include a CT scan and endoscopy. The gastroenterology team should be involved in care. Our Surgeons at Surgical Gastroenterology Center at MH Surgery Clinic are well trained in managing such complex situations where prompt diagnosis and management for better patient outcome.