A CLINICAL STUDY ON GASTRIC OUTLET OBSTRUCTION

Abstract

INTRODUCTION 
 Gastric outlet obstruction (GOO) is obstruction in the first part of duodenum secondary to cicatrised duodenal ulcer or 
 proximally where the diagnosis of carcinoma is most probable. GOO can be a diagnostic and treatment dilemma. Once a 
 mechanical obstruction is confirmed, differentiate between benign and malignant processes. Cicatrized duodenal ulcer was the 
 most common cause of GOO. But with increased awareness, change in the dietary habits and availability of H2 receptor 
 blockers and Proton Pump Inhibitors and H pylori kits all have resulted in decreased incidence of patients requiring surgery 
 and also the complications like pyloric stenosis have reduced. At the same time the incidence of antral carcinoma of stomach 
 producing GOO has comparatively increased, which may be due to increased early diagnosis of the condition with the help of 
 flexible fibro optic endoscope. 
 
 AIMS & OBJECTIVES 
 To study and identify the cause of cases of GOO with respect to benign peptic ulcer and malignancy of stomach. 
 
 MATERIALS AND METHODS 
 An observational study comparing of 30 cases of GOO. An elaborate study of the cases with regard to history, clinical 
 features, routine and special investigation, pre operative treatment, operative findings, post operative management and 
 complications in the post operative period is done. Apart from routine surgical profile special investigations like serum 
 electrolytes, barium meal study, Upper GI Endoscopy and ultrasound abdomen and pelvis will be carried. For peptic ulcer 
 disease truncal vagotomy with posterior gastrojejunostomy was done and for carcinoma partial gastrectomy with Billroth II 
 reconstruction or anterior GJ or palliative resection with anterior GJ were done. 
 
 INCLUSION CRITERIA 
 1. Peptic ulcer disease 2. Carcinoma pyloric antrum, 3. Benign neoplasm of stomach. 
 
 EXCLUSION CRITERIA 
 1. Carcinoma stomach with liver metastasis, ascites, peritoneal implantation, 2. Gastro duodenal tuberculosis. 
 
 ETHICAL ISSUES 
 Informed written consent will be taken from patients before including them in the study. 
 
 SUMMARY OF RESULTS 
 1. The most common cause of gastric outlet obstruction is carcinoma stomach with antral growth in 53.3% producing GOO in 
 the study. 2. Number of cases with cicatrized duodenal ulcer causing GOO were 43.3%. 3. One case of stenosis following 
 corrosive acid ingestion was also present as the reason for GOO in the study 3.3%. 4. Males are more commonly affected 
 than female and the male female ratio is 7:1 in malignancy. 5. This study was undertaken in an adult rural population. 6. The 
 most common presenting complaints were vomiting (100%), abdominal pain (90%) and loss of appetite (90%). In malignant 
 cases loss of weight (93%) was also a common complaint. 7. Visible gastric peristalsis and succession splash were less 
 prominent in malignant cases when compared to stenosing duodenal ulcer cases. 8. 31% of the malignant cases presented 
 with mass in the upper abdomen. 9. Only 5 cases of malignancy could be able to undergo definite surgical procedure. All 
 others underwent palliative procedures.10.The surgical procedure undertook in the cicatrized duodenal ulcer patients were 
 truncal vagotomy and posterior GJ and there were no recurrence of symptoms in any of the casers which turned up for follow 
 up. 11. The mortality rate was 18.8% in malignant cases. 
 
 CONCLUSION 
 1. The most common cause of gastric outlet obstruction in adults are carcinoma stomach with antral growth producing GOO in 
 53.3% and cicatrized duodenal ulcer causing GOO were 43.3%. 2. In the vast majority of cases the diagnosis can be 
 established clinically. 3. The saline load test was found to be effective bedside investigations to assess the degree of GOO. 4. 
 Upper GI endoscopy should be mandatory in all suspected cases of GOO. 5. Number of cases with cicatrized duodenal ulcer as 
 the chief etiological factors for GOO is diminishing and the number of cases of antral carcinoma of stomach as the cause of 
 GOO is increasing. 6.Effective treatment in carcinoma stomach depends on early diagnosis.