Etiological study of Gastric Outlet Obstruction in the era of advanced medical treatment of Peptic Ulcer Diseases

Abstract

Introduction: Although the incidence of gastric outlet obstruction (GOO) is decreasing in the world with improvement of advanced medical treatment, still this is a common disease in surgical practice. Two most common causes of GOO are gastric cancer and pyloric stenosis secondary to peptic ulcer disease (PUD). Objectives: To determine the relative incidence of malignant and non-malignant pathology in patients presenting with GOO in this era of advanced medical treatment. Methods: A retrospective study is carried out in Sheikh Sayera Khatun Medical College Hospital. The records of 50 consecutive patients, admitted in surgery ward with features of GOO from July 2019 to June 2020 were reviewed. Results: The mean age of the patients is 45.5 years, with male preponderance (84%, M: F-5.25:1), most presented after 4th decade of life. All (100%) presented with characteristic vomiting. Others are epigastric pain (60%), bleeding (30%) indicated by haematemesis and melena, anorexia (52%) and marked weight loss (62%). Epigastric fullness (60%) and epigastric mass (20%) indicating advanced malignant lesion; 82% had past history of PUD, 88% were either smoker or habituated to betel nut and betel leaf, 72% belongs to low socioeconomic condition. Majority (70%) were anaemic, 6% icteric, 78% severely dehydrated. Visible peristalsis seen in 46% patients and succussion splash in 54%. Four malignant case had virchow’s gland. Ascites in 20% and hepatomegaly 8% cases, representing advanced malignancy and signs of inoperability. Post-operative complications were more in malignant than benign cases mostly wound infection and wound dehiscence. Two patients in malignant group developed duodenal stump leakage and ultimately died. Most common cause of GOO was benign pyloric stenosis or oedema and spasms associated with acute ulcers in pylorus or duodenum (48%) which is followed immediately by antral carcinoma (46%), and extra gastric tumors (6%). Conclusions: The relative incidence of GOO due to pyloric stenosis secondary to chronic duodenal ulcer is more than antral carcinoma, observed in this series; but when considered antral carcinoma combined with other malignancies, pyloric stenosis is a relatively less common cause of GOO. Multicenter study is required to get the real picture in our country to find out the actual cause of GOO.