🚫🍲 Severe Gastric Outlet Obstruction (GOO) in adults is potentially life-threatening.
🔎 Always exclude functional/non-mechanical causes (e.g., diabetic gastroparesis).
⏱️ Prompt diagnosis & intervention are essential to prevent complications such as dehydration, metabolic derangements, and renal impairment.
| ⚠️ Severe Gastric Outlet Obstruction (Pyloric Stenosis) – Adult Management |
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- 🔬 Causes: Malignant (gastric, pancreatic, ampullary, cholangiocarcinoma, lymphoma) or benign (peptic ulcer disease, chronic scarring, bezoars).
- 🫁 ABC + IV fluids – correct dehydration, hypokalaemia, hypochloraemia; monitor U&E, creatinine.
- 🚫 Nil by mouth + 🧴 NG tube decompression to relieve distension and stop vomiting.
- 🍽️ Nutrition: Consider jejunostomy or TPN if enteral feeding fails; monitor electrolytes.
- 🩺 Early MDT involvement for malignant GOO – coordinate oncology, surgery, endoscopy.
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ℹ️ About
- Historically caused by benign peptic ulcer scarring; currently most adult GOO is malignant (gastric or pancreatic). 🏥
- Functional causes (gastroparesis, post-surgical) should be excluded before intervention.
🩺 Causes
- 🎗️ Malignancy: pancreatic, gastric, duodenal, ampullary, cholangiocarcinoma, lymphoma.
- 🌀 Chronic PUD scarring/stenosis – H. pylori associated.
- 🍏 Foreign body – bezoars.
- 👶 Congenital pyloric stenosis – mainly infants.
👨⚕️ Clinical Features
- 🤢 Post-prandial vomiting of undigested or stale food (non-bilious).
- 🔥 Dyspepsia or epigastric discomfort.
- ⚖️ Weight loss, cachexia, dehydration.
- 🩺 Succussion splash >4 hours after eating; visible peristalsis sometimes.
🔬 Investigations
- 🧪 Bloods: FBC (anaemia), U&E (dehydration/AKI), electrolytes – ⬇️ K⁺, ⬇️ Cl⁻, ⬆️ HCO₃⁻ → metabolic alkalosis.
- 🚽 Paradoxical acidic urine despite alkalosis.
- 📸 AXR: distended stomach, air-fluid levels.
- 🧴 NG aspirate: >200 mL overnight suggests obstruction.
- 🥛 Barium meal/swallow: delayed gastric emptying, localisation of obstruction.
- 📹 OGD/endoscopy: visualisation, biopsy to exclude malignancy.
- 🖥️ CT abdomen: staging, local invasion, or external compression.
🛠️ Management
- 💧 IV fluids + electrolyte correction (K⁺, Cl⁻, Mg²⁺ if low).
- 💊 PPI therapy ± H. pylori eradication if ulcer-related.
- 🔪 Benign obstruction: pyloroplasty, antrectomy, or partial gastrectomy if patient fit.
- 🌉 Malignant obstruction: gastrojejunostomy (surgical bypass) or endoscopic self-expanding metal stent (SEMS) for palliation or poor surgical candidates.
- 🎗️ Oncological management: chemotherapy or radiotherapy if tumour-related, coordinated via MDT.
- 🧴 Nutritional support: consider enteral feeding via jejunostomy or TPN if prolonged obstruction.
- 🩺 Close monitoring for refeeding syndrome, renal function, and metabolic derangements.
📚 Key Points
- Early NG decompression and IV correction of fluids/electrolytes is critical. 🫁
- Malignancy is the most common cause in adults; always biopsy obstructing lesion. 🎗️
- Functional causes (gastroparesis, post-vagotomy, diabetes) must be ruled out. 🔎
- Multidisciplinary approach improves outcomes: gastroenterology, surgery, oncology, dietetics. 🤝
Case – Adult Gastric Outlet Obstruction
72-year-old presents with weeks of early satiety, post-prandial vomiting of stale food, and weight loss; exam shows visible peristalsis with a succussion splash, mild epigastric tenderness, and dehydration. Labs reveal hypochloraemic, hypokalaemic metabolic alkalosis and AKI stage 1.
Initial management: NBM, large-bore NG decompression, aggressive IV fluids with potassium/chloride replacement, PPI.
CT abdomen shows distal gastric narrowing; OGD confirms antral/pyloric stricture with biopsies to exclude malignancy (common causes: gastric cancer, pancreatic cancer, less often peptic ulcer scarring).
Definitive options: endoscopic balloon dilation or stenting for benign/palliative disease, or surgical bypass/resection guided by MDT and staging.
