Gastric Outlet Obstruction

Basics

Description

  • Any process causing mechanical obstruction of gastric emptying at the level of the pylorus, distal stomach, or duodenum
  • Causes not limited to gastric pathology and may be duodenal or extraluminal in origin
  • Regardless of exact cause, gastric outlet obstruction characteristically leads to nausea, nonbilious vomiting, early satiety, and epigastric pain
  • Persistent vomiting may lead to dehydration, electrolyte and acid–base derangements:
    • Chronic symptoms may lead to weight loss, malnutrition, failure to thrive
    • Hypokalemic, hypochloremic metabolic alkalosis is the classic finding

Etiology

  • Neoplasms (most common cause in adults):
    • Intrinsic or extrinsic neoplasms (pancreatic, gastric, duodenal, gallbladder) causing compression at the pylorus or proximal duodenum
  • Pyloric stenosis (most common pediatric cause):
    • Incidence 2–5/1000
  • Peptic ulcer disease (PUD) is now less common due to the treatment of Helicobacter pylori and use of H2 blockers
  • Postoperative complications, particularly from gastric surgeries, or radiation (eg, edema, scarring, stricture, or hyperplasia of pylorus or duodenum)
  • Mechanical causes: gastric volvulus, polyps, bezoars, corrosive ingestion, duplication cysts, edema, scarring, strictures/webs, or hyperplasia of pylorus or duodenum from various causes (eg, chronic pancreatitis, Crohn’s)

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