A Clinicopathological Study On Gastric Outlet Obstruction In Adults

BACKGROUNDGastric outlet obstruction (GOO) is a clinical and pathophysiological consequence of any disease process that produces a mechanical impediment to gastric emptying which may be extrinsic or intrinsic. GOO may be caused by a heterogeneous group of diseases that include both benign and malignant conditions. 1,2 Until the late 1970s, benign disease was responsible for the majority of cases of GOO in adults. By contrast, in recent decades, 50 to 80 percent cases have been attributable to malignancy.Aim-1. To study the incidence of various aetiologies causing GOO. 2. To observe the benign versus malignant conditions as aetiological cause. 3. To follow the surgeries done for cases of GOO and to study their surgical outcome.MATERIALS AND METHODSThis prospective study has been conducted on patients attending to Surgical Department, Government General Hospital, Kakinada during the period of July 2012 to august 2014. 55 patients of GOO have been studied.RESULTSOut of 55 cases studied, 35 are due to malignant causes out of which 28 are due to Carcinoma stomach, 7 due to other malignancies and 20 cases due to cicatrising duodenal ulcer. Most of cases of GOO present in the 5th decade of life followed by 6th decade. Both malignant and benign aetiologies were high in this age group. Carcinoma stomach male to female ratio is 2: 1 and chronic duodenal ulcers are seen in ratio of 6: 1. Vomiting and epigastric pain are the most common symptoms in this series. Visible gastric peristalsis is seen in 30 cases accounting to 63% of total cases. Dehydration is other common presentation seen 54% of cases followed by anaemia in 53% of cases. Succussion splash is heard in 36% of cases, palpable mass in 25% of cases and ascites in 15% of cases. Truncal vagotomy and gastrojejunostomy is done in 19 cases (34%) of cases. Distal gastrectomy with Billroth II reconstruction is done in 13 cases of Ca stomach (23% of total cases). Palliative gastrojejunostomy is done in 14 cases ( 25%). Total gastrectomy in 1 case feeding jejunostomy in one case. Palliative gastrojejunostomy with hepaticojejunostomy is done in 6 cases and in one case palliative cholecystojejunostomy with gastrojejunostomy was done.CONCLUSIONThe present study gives an insight into presentation of GOO and its aetiology.Commonest cause of GOO in adults is carcinoma stomach followed by cicatrising duodenal ulcer.GOO is common in males in 5th decade.UGIE is the investigation of choice.Malignant GOO had poor prognosis and mostly palliation is done.It focuses on the fact that there is delayed presentation with patients of upper gastrointestinal malignancy.