Gastric dysplasia causing gastric outlet obstruction

2021 ◽  
Vol 14 (7) ◽  
pp. e243208
Author(s):  
Rahul Kumar ◽  
Ipsit Ilahi ◽  
Tripti Prajapati ◽  
Pankaj Kumar Garg
Keyword(s):  
Gastric Outlet Obstruction ◽  
Distal Gastrectomy ◽  
Histopathological Examination ◽  
Outlet Obstruction ◽  
Endoscopic Biopsy ◽  
Tissue Growth ◽  
Radiological Findings ◽  
Gastric Dysplasia ◽  
Gastric Contents ◽  
Atypical Cells

Gastric dysplasia signifies the presence of atypical cells in the gastric mucosa, which have not invaded beyond the lamina propria, and it rarely leads to tissue growth large enough to cause gastric outlet obstruction (GOO) to the gastric contents. However, GOO is commonly observed as a first clinical manifestation of advanced invasive gastric cancer in developing countries where patients seek medical care late. The present case highlights the treatment journey of a young woman who presented to us with features of GOO. Her endoscopic and radiological findings revealed a nodular gastric antral thickening causing GOO. An endoscopic biopsy showed features of dysplasia. She underwent distal gastrectomy following discussion in a multidisciplinary tumour board. Histopathological examination of the gastrectomy specimen confirmed dysplasia without any invasion beyond lamina. To the best of our knowledge, this is perhaps the first report of dysplasia of the stomach presenting as GOO.

scholarly journals A case report of duodenal carcinoid tumor causing gastric outlet obstruction

2021 ◽  
Vol 8 (7) ◽  
pp. 2176
Author(s):  
Aftab Shaikh ◽  
Sachin Sholapur ◽  
Amarjeet Tandur
Keyword(s):  
Case Report ◽  
Gastric Outlet Obstruction ◽  
Distal Gastrectomy ◽  
Histopathological Examination ◽  
Regional Lymph Node ◽  
Outlet Obstruction ◽  
Neuron Specific Enolase ◽  
R0 Resection ◽  
Early Management ◽  
Duodenal Carcinoid

Carcinoids are tumours of neuroendocrine origin. Commonly found in gastrointestinal and respiratory tracts, however, duodenal carcinoids among them are comparatively rare. Duodenal carcinoids presenting as acute gastric outlet obstruction are even rarer. Clinically difficult to diagnose due to their non-specific presentation. Endoscopic ultrasound (EUS), computed tomography (CT) and immunohistochemistry (IHC) for markers like chromogranin A, neuron specific enolase (NSE), synaptophysin helps in making a definitive diagnosis. Management is influenced by multiple factors like size, site, metastases and regional lymph node involvement. Here is a case report of solitary duodenal carcinoid complicated with acute gastric outlet obstruction. A middle-aged female with chronic history of intractable dyspepsia, bloating and occasional vomiting, on thorough evaluation with upper GI endoscopy, EUS guided biopsy, CT scan and histopathological examination was diagnosed of a solitary 2.2×1.2×1.6 cm sized duodenal carcinoid tumour. Patient had no past, family or genetic history supporting the diagnosis. Patient presented with features of acute gastric outlet obstruction 1 week after the diagnosis which required a distal gastrectomy with resection of first part of duodenum followed by a Roux-en-Y gastrojejunostomy with an uneventful 6 month follow up.  As the size in this case was more than 2 cm with AJCC staging of T2N0M0, distal gastrectomy with Roux-en-Y gastrojejunostomy was done to ensure an R0 resection and to relieve the gastric outlet obstruction. Duodenal carcinoids presenting as gastric outlet obstruction are not common. Early management is essential to prevent complications like gastric outlet obstruction despite of indolent course of the disease.

scholarly journals A rare case of primary gastric tuberculosis presenting as gastric outlet obstruction mimicking malignancy

2018 ◽  
Vol 4 (10) ◽  
pp. 263
Author(s):  
Kanika Singh ◽  
Sujata Raychaudhuri ◽  
Sheetal Gole ◽  
Anu Aggarwal
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Rare Condition ◽  
Surgical Excision ◽  
Giant Cells ◽  
Endoscopic Biopsy ◽  
Gastric Tuberculosis

<p>Gastric tuberculosis (TB), both primary and secondary is a rare condition. It is less common in immunocompetent individuals and in those without any antecedent pulmonary infection. The nonspecific complaints like epigastric pain, vomiting and weight loss may be confounding and lead to difficulty in diagnosis and differential diagnosis may include adenocarcinoma. We present a case of an immunocompetent male who presented with the above mentioned symptoms and on endoscopy showed an ulcerated region in the pyloric antrum with gastric outlet obstruction. A differential diagnosis of adenocarcinoma was suggested by the clinician. The endoscopic biopsy revealed granulomas and giant cells with no evidence of dysplasia. However, Ziehl-Neelson stain for acid fast bacilli was negative. The diagnosis of gastric tuberculosis was confirmed on Polymerase chain reaction (PCR) test for TB. A possibility of gastric tuberculosis should always be kept in mind in an endemic country like India with nonspecific abdominal complaints like epigastric pain, weight loss, vomiting etc. along with other differential diagnosis. A correct clinicopathological diagnosis would help in the appropriate treatment of the patient and would prevent unnecessary surgical excision.</p>

Radiological findings of gastric adenomyoma in a neonate presenting with gastric outlet obstruction

2012 ◽  
Vol 43 (5) ◽  
pp. 628-630 ◽  
Author(s):  
Jung Hyo Rhim ◽  
Woo Sun Kim ◽  
Young Hun Choi ◽  
Jung-Eun Cheon ◽  
Sung Hye Park
Keyword(s):  
Gastric Outlet Obstruction ◽  
Outlet Obstruction ◽  
Radiological Findings

scholarly journals Combined Aggressive Distal Gastrectomy and Double-Tract Reconstruction for Palliation of Incurable Locally Invasive Distal Gastric Cancer With Gastric Outlet Obstruction

2019 ◽  
Vol 103 (11-12) ◽  
pp. 593-599
Author(s):  
Yoshito Kiyasu
Keyword(s):  
Gastric Cancer ◽  
Gastric Outlet Obstruction ◽  
Distal Gastrectomy ◽  
Outlet Obstruction ◽  
Operation Time ◽  
Abdominal Sepsis ◽  
Peritoneal Lavage Cytology ◽  
Double Tract Reconstruction ◽  
Distal Gastric Cancer ◽  
The Mean

Objective: To evaluate combined aggressive distal gastrectomy (ADG) and double-tract (DT) reconstruction (ADGDTR) for palliative treatment of gastric cancer with gastric outlet obstruction (GOO). Summary of Background Data: An effective standard palliation procedure has not been identified for patients with incurable gastric cancer. Methods: I retrospectively evaluated patients presenting to my clinic with GOO secondary to locally invasive distal gastric cancer between March 1996 and March 2011. Following a complete workup, patients underwent ADGDTR. ADG included the gastric tumor in whole or in part. DT reconstruction consisted of gastrojejunostomy, jejunoduodenostomy, and jejunojejunostomy. Results: In the enrolled patients (n = 7; 5 male; mean age, 71 years [range, 60–83 years]), preoperative comorbidities included anemia (7), diabetes mellitus (2), hepatic cirrhosis (1), cardiac ischemia (1), and Parkinson disease (1). The lesion invaded the pancreas in all patients, and the transverse mesocolon, liver, and mesentery were each involved in 1 patient. Metastatic disease affected the lymph nodes in 5 patients, liver in 1, and peritoneal cavity in 4. Peritoneal lavage cytology was positive in 3 patients and untested in 4. The mean operation time was 207 minutes (range, 150–295 minutes), and mean blood loss was 290 g (range, 110–480 g). Six patients had no postoperative complications, but 1 died of abdominal sepsis. The mean length of hospitalization was 43 days (range, 28–73 days), and mean survival was 8.3 months (range, 2–22 months). Six patients tolerated a low-residue or regular diet postoperatively. Conclusions: ADGDTR provided effective, low-risk palliation and long-term oral ingestion in patients with incurable, locally invasive distal gastric cancer with GOO.

scholarly journals Prolapsing Gastric Polyp Causing Intermittent Gastric Outlet Obstruction

2015 ◽  
Vol 100 (6) ◽  
pp. 1148-1152 ◽  
Author(s):  
Nik Ritza Kosai ◽  
Hardip Singh Gendeh ◽  
Abdul Rashid Norfaezan ◽  
Jamin Razman ◽  
Paul Anthony Sutton ◽  
...  
Keyword(s):  
Gastric Outlet Obstruction ◽  
Distal Gastrectomy ◽  
Incidental Finding ◽  
Outlet Obstruction ◽  
Gastric Ulcers ◽  
Upper Gastrointestinal Endoscopy ◽  
Polyp Size ◽  
Gastric Polyps ◽  
Gastric Polyposis ◽  
H Pylori

Gastric polyps are often an incidental finding on upper gastrointestinal endoscopy, with an incidence up to 5%. The majority of gastric polyps are asymptomatic, occurring secondary to inflammation. Prior reviews discussed Helicobacter pylori (H pylori)–associated singular gastric polyposis; however, we present a rare and unusual case of recurrent multiple benign gastric polyposis post H pylori eradication resulting in intermittent gastric outlet obstruction. A 70-year-old independent male, Chinese in ethnicity, with a background of diabetes mellitus, hypertension, and a simple renal cyst presented with a combination of melena, anemia, and intermittent vomiting of partially digested food after meals. Initial gastroscopy was positive for H pylori; thus he was treated with H pylori eradication and proton pump inhibitors. Serial gastroscopy demonstrated multiple sessile gastric antral polyps, the largest measuring 4 cm. Histopathologic examination confirmed a benign hyperplastic lesion. Computed tomography identified a pyloric mass with absent surrounding infiltration or metastasis. A distal gastrectomy was performed, whereby multiple small pyloric polyps were found, the largest prolapsing into the pyloric opening, thus explaining the intermittent nature of gastric outlet obstruction. Such polyps often develop from gastric ulcers and, if left untreated, may undergo neoplasia to form malignant cells. A distal gastrectomy was an effective choice of treatment, taking into account the polyp size, quantity, and potential for malignancy as opposed to an endoscopic approach, which may not guarantee a complete removal of safer margins and depth. Therefore, surgical excision is favorable for multiple large gastric polyps with risk of malignancy.

scholarly journals Gastric Outlet Obstruction due to Intramural Duodenal Hematoma after Endoscopic Biopsy: Possible Therapeutic Role of Endoscopic Dilation

2018 ◽  
Vol 12 (3) ◽  
pp. 692-698
Author(s):  
Mahmud Samra ◽  
Tarek Al-Mouradi ◽  
Charles Berkelhammer
Keyword(s):  
Abdominal Pain ◽  
Gastric Outlet Obstruction ◽  
Rare Complication ◽  
Outlet Obstruction ◽  
Abdominal Ultrasound ◽  
Endoscopic Biopsy ◽  
Duodenal Hematoma ◽  
Bowel Rest ◽  
Diagnostic Modalities ◽  
Duodenal Lumen

Intramural duodenal hematoma (IDH) is an extremely rare complication after endoscopic biopsy. It typically presents with symptoms due to duodenal obstruction, which include abdominal pain and bilious vomiting. The hematoma may also expand and cause ampullary compression leading to pancreatitis and cholestasis. Computed tomography scan and abdominal ultrasound are the most common diagnostic modalities. Treatment is usually conservative, with bowel rest, nasogastric suctioning and total parenteral nutrition. Refractory cases have been described, requiring endoscopic therapy or surgical drainage. We describe a 28-year-old healthy male who presented with acute abdominal pain a few hours after a routine esophagogastrodudenoscopy with biopsies was performed. Following an otherwise uneventful endoscopy, he developed a gastric outlet obstruction and pancreatitis secondary to an IDH. The patient was managed conservatively. Resolution of his gastric outlet obstruction occurred immediately after gentle passage of the endoscope through the narrowed duodenal lumen.

scholarly journals Isolated Gastro-Duodenal Tuberculosis Mimics Peptic Ulcer Disease in a Young Female

2019 ◽  
Vol 9 (3) ◽  
pp. 189-192
Author(s):  
Mohammad Quamrul Hasan ◽  
Nelson Taposh Mondal ◽  
Md Haroon Ur Rashid ◽  
Rukhsana Parvin ◽  
Irin Perveen
Keyword(s):  
Histopathological Examination ◽  
Intestinal Tuberculosis ◽  
Outlet Obstruction ◽  
Giant Cells ◽  
Young Female ◽  
Endoscopic Biopsy ◽  
Chronic Ulcer ◽  
Ulcer Disease ◽  
Epitheloid Cells ◽  
High Degree

Intestinal tuberculosis (TB) most commonly affects ileo-caecal region. Isolated gastric and duodenal involvement without pulmonary infection is rare. The presentation of these patients varies. Patients may present with haematemesis, non-healing chronic ulcer, mimicking malignancy, gastric perforation and gastric outlet obstruction. High degree of suspicion is needed for early diagnosis of gastro-duodenal TB. A young female patient who was being treated as a case of nonhealing chronic ulcer was referred for treatment. Histopathological examination of endoscopic biopsy specimen of the patient showed presence of granulomas composed of epitheloid cells and Langhan’s giant cells with caseation with no evidence of tuberculosis at pulmonary or other body sites. After anti-tubercular chemotherapy there was resolution of symptoms and healing of ulcers. This case of isolated gastro-duodenal TB is reported for its rarity. J Enam Med Col 2019; 9(3): 189-192

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