A pathological study on gastric outlet obstruction

Selladurai, P (2012) A pathological study on gastric outlet obstruction. Masters thesis, Tirunelveli Medical College, Tirunelveli.

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Abstract

INTRODUCTION: Gastric outlet obstruction is due to obstruction in first part of duodenum at the site of chronic scarring from ulceration or antrum where a benign gastric ulcer (type II and type III) or carcinoma is a problem. Stenotic complications of peptic ulcer disease are hour glass deformity and tea pot deformity (gastric ulcer). Stenotic complications arise from repeated cycles of ulceration and healing resulting in dense fibrosis with narrowing and deformity. Common causes of gastric outlet obstruction are 1. Chronic duodenal ulceration / fibrosis, 2. Antral gastric carcinoma, 3. Carcinoma of the head of pancreas, 5. Annular pancreas, 6. Mucosal diaphragm, 7. Megaduodenum, 8. Arteriomesenteric compression (Wilke’s disease). Clinical features of gastric outlet obstruction: a. Abdomen pain, b. Upper abdominal discomfort, c. Vomiting (effortless, projectile, absence of bile, presence of partially digested food eaten hours or days previously), d. Constipation. Rare causes of gastric outlet obstruction: 1. Lymphomas, 2. Crohn’s disease, 3. Duodenal haematoma, 4. Adult pyloric hypertrophy. AIM OF THE STUDY: 1. Age and sex incidence of gastric outlet obstruction. 2. Pathological study on causes of gastric outlet obstruction. 3. Correlate the results of upper gastrointestinal endoscopy, biopsy and peroperative findings in gastric outlet obstruction. MATERIALS AND METHODS: This was a pathological study on gastric outlet obstruction comprising of 34 cases of gastric outlet obstruction. The patients have been selected from Tirunelveli Medical College Hospital in the Surgery department from December 2010 to December 2011. The cases were selected with following inclusion and exclusion criteria. Inclusion Criteria: 1. Peptic ulcer disease with gastric outlet obstruction. 2. Carcinoma pyloric region with gastric outlet obstruction. Exclusion Criteria: 1. Infantile hypertrophic pyloric stenosis, 2. Congenital lesion, 3. Gastro intestinal tuberculosis. An elaborate study of all the patients with regard to history, clinical features, routine investigations, endoscopy and biopsy report, pre operative management, per-operative findings, post operative management and complications during post operative period is managed. Patient general condition, nutrition status, hydration and co-morbid conditions were managed before surgery. RESULTS: Gastric outlet obstruction is common in age less than 50 years is 14 (40%). In 10 patients it is due to malignancy and in 4 patients it is due to benign lesion. In age between 50 to 55 years 8 pateints (24%) develop gastric outlet obstruction. In 7 patients the cause is malignant lesion and in one patient the cause is cicatrized duodenal ulcer in 1st part of duodenum. In age between 56 to 60 years 4 patients had gastric outlet obstruction and in all 4 patients cause was malignant lesion. In age between 61 to 65 years 5 patients had gastric outlet obstruction. In 3 patients the cause is malignant lesion and in 2 patients it was due to benign lesion. In age above 65 years 3 patients develop gastric outlet obstruction and the cause is malignant lesion. In this study young age to develop gastric outlet obstruction is 30 years due to cicatrized duodenal ulcer and oldest age is 75 years due to gastric carcinoma. The age incidence is 30 to 75 years with mean of 52.5 years. The young age to develop gastric carcinoma is 35 years. CONCLUSION: The present study is a pathological study on gastric outlet obstruction. The observations from the data and results obtained in the present study were Male patients are more commonly affected by gastric outlet obstruction. Carcinoma in pyloric antral region was the most common cause of gastric outlet obstruction. Vomiting and dehydration are the common symptoms and signs of gastric outlet obstruction. Upper gastro intestinal endoscopy and biopsy are the Gold standard investigation for gastric outlet obstruction. It has been used for both diagnostic purpose and taking biopsy from the lesion. Patient general condition, correction of anemia, fluid and electrolyte imbalance and preparation of stomach must be done preoperatively. Patients with gastric outlet obstruction due to cicatrized duodenal ulcer require truncal vagotomy with posterior gastrojejunostomy. In patients with carcinoma pyloric antral region require curative surgery in early stage or a palliative surgery depending on the stage of the disease. All patients above 40 years with symptoms of dyspepsia should undergo upper gastro intestinal endoscopy and biopsy examination.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Gastric Outlet Obstruction, Pathological study.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 09 Jun 2018 17:30
Last Modified: 15 Sep 2020 15:49
URI: http://repository-tnmgrmu.ac.in/id/eprint/8358

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