Gastric Outlet Obstruction in Western India– A Retrospective Analysis

Abstract

Background

Gastric outlet obstruction (GOO) or pyloric obstruction is not a single entity. The clinical and pathophysiological consequence of many disease processes produces a mechanical obstruction to gastric emptying.

Methods

Total patients 89 patients attending the Surgical Gastroenterology Department of NHL Municipal Medical College, Ahmedabad, from December 2016 to December 2019 with chief complaints of projectile vomiting, visible gastric peristalsis or palpable distended stomach, diagnosed as GOO from UGI endoscopy and barium meal study were included in this study. Cases of the functional non-mechanical causes of GOO were excluded along with the pediatric age group. Only patients of 12 years and above were included in this study.

Results

Out of 89 cases studied, 46 were due to corrosive ingestion, 24 with malignant causes, out of which 20 were due to Carcinoma stomach, another three were due to GIST, and 1 case was due to carcinoma gall bladder infiltrating duodenum. 11 cases were due to cicatrizing duodenal ulcer and rest 8 cases duet to pseudocyst of the pancreas. Most of them belong to low socioeconomic status. The average age of GOO due to corrosive was 31.2 yrs, for gastric neoplasia 53.6 yrs, for peptic ulcer disease 41.3 yrs, and 30.4 yrs for pseudocyst of the pancreas. GOO due to corrosive ingestion was more common in females, but in the case of neoplasia, male preponderance was seen. Radical D-2 gastrectomy was performed for adenocarcinoma of the stomach and nonradical surgery for the rest; palliative GJ was done in 1 case. Morbidity in this study was 11.2 %, and mortality was 1.2 %.

Conclusion

Due to corrosive ingestion, GOO is common in western India; good clinical outcomes are seen if the patients are managed in a staged manner, i.e., improvement of nutritional status followed by definitive surgical management. Diversion gastrojejunostomy without resection of the cicatrized stomach gives acceptable outcomes.