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      Gastric outlet obstruction secondary to peptic ulcer disease, previously misdiagnosed as idiopathic hypertrophic pyloric stenosis in a 16-year-old girl: a case report

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          Abstract

          Gastric outlet obstruction encompasses a broad spectrum of conditions characterized by complete or incomplete obstruction of the distal stomach, which interrupts gastric emptying and prevents the passage of gastric contents beyond the proximal duodenum. Idiopathic hypertrophic pyloric stenosis is the most common cause with an incidence of 1.5–3 per 1000 live births. However, it is excluded; other causes in children such as peptic ulcer disease are relatively rare. We report a case of an acquired gastric outlet obstruction due to peptic ulcer disease, previously misdiagnosed as idiopathic hypertrophic pyloric stenosis in a 16-year-old girl. Beyond the rarity of this clinical event, this case highlights the challenges of the aetiological diagnosis of gastric outlet obstruction with subsequent therapeutic issues, and is the first documented case in Cameroon.

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          Rare causes of gastric outlet obstruction in children.

          Xiu Wei, Winnie Li, Weizhong Gu … (2005)
          Gastric outlet obstruction (GOO) presenting beyond the newborn period is a relatively rare condition, when infantile hypertrophic pyloric stenosis (IHPS) is excluded. This report describes the clinical features, evaluation and management of 18 patients with GOO which was not caused by IHPS. The sex, age, and main presenting features were recorded on admission. Hemoglobin estimation, serum chemistry and blood gas analysis were also assessed in these patients. The diagnosis was confirmed with gastrointestinal barium, B ultrasound, gastroscopy, or at surgery. Some of them underwent gastroscopy with biopsy sampling for rapid urease test or histologic examination with Giemsa stains for Helicobacter pylori. Thirteen patients had peptic ulcer disease, of which six were successfully treated with medications. While the other seven needed operative management which included Heineke-Mikulicz pyloroplasty, gastroduodenostomy or gastrojejunostomy, respectively. All the patients who had Heineke-Mikulicz pyloroplasty or gastrojejunostomy developed bile reflux gastritis that could be alleviated with omeprazol. None of the patients developed dumping syndrome, failing to thrive, or anemia. Three children with antral diaphragm recovered without any complications by diaphragm excision with Heineke-Mikulicz pyloroplasty. The pylorus was compressed by fibrotic band in one 30-month boy, and he recovered uneventfully with Heineke-Mikulicz pyloroplasty during 10-year follow-up. Gastric outlet obstruction secondary to ingestion of sulfuric acid was noted in one patient, and he was successfully treated with gastroduodenostomy. Our data suggests that the satisfactory results could be expected in children with GOO with different therapeutic modalities based on the specific cause and degree of obstruction.
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            Gastric outlet obstruction at Bugando Medical Centre in Northwestern Tanzania: a prospective review of 184 cases

            Hyasinta Jaka, Mabula Mchembe, Peter F Rambau … (2013)
            Background Gastric outlet obstruction poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. There is a paucity of published data on this subject in our setting. This study was undertaken to highlight the etiological spectrum and treatment outcome of gastric outlet obstruction in our setting and to identify prognostic factors for morbidity and mortality. Methods This was a descriptive prospective study which was conducted at Bugando Medical Centre between March 2009 and February 2013. All patients with a clinical diagnosis of gastric outlet obstruction were, after informed consent for the study, consecutively enrolled into the study. Statistical data analysis was done using SPSS computer software version 17.0. Results A total of 184 patients were studied. More than two-third of patients were males. Patients with malignant gastric outlet obstruction were older than those of benign type. This difference was statistically significant (p 60 years, co-existing medical illness, malignant cause, HIV positivity, low CD 4 count (<200 cells/μl), high ASA class and presence of surgical site infection significantly predicted mortality ( p< 0.001). The follow up of patients was generally poor as more than 60% of patients were lost to follow up. Conclusion Gastric outlet obstruction in our setting is more prevalent in males and the cause is mostly malignant. The majority of patients present late with poor general condition. Early recognition of the diagnosis, aggressive resuscitation and early institution of surgical management is of paramount importance if morbidity and mortality associated with gastric outlet obstruction are to be avoided.
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              Usual and unusual causes of pediatric gastric outlet obstruction.

              Jeffrey P. Otjen, Ramesh S. Iyer, Grace S. Phillips … (2012)
              Gastric outlet obstruction in children encompasses a spectrum of disorders that extends beyond hypertrophic pyloric stenosis. Each condition can result in the clinical syndrome of persistent nonbilious vomiting, which can progress to dehydration and electrolyte imbalances. This paper reviews the spectrum of both the common and uncommon entities that cause partial or complete gastric outlet obstruction and their imaging appearances. The correct diagnosis of those with gastric outlet obstruction can be achieved by combining clinical presentation with appropriate imaging, leading to optimal and timely patient management.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (iso-abbrev): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: July 2020
                Publication date (Electronic): 20 July 2020
                Publication date PMC-release: 20 July 2020
                Volume: 2020
                Issue: 7
                Electronic Location Identifier: rjaa232
                Affiliations
                [1 ] Department of Surgery , Mbouo Protestant Hospital , Bandjoun, Cameroon
                [2 ] Faculty of Medecine and Biomedical Sciences , University of Yaounde I , Yaounde, Cameroon
                [3 ] Department of Surgery , Yaounde Central Hospital , Yaounde, Cameroon
                [4 ] Department of Radiology and Medical Imaging , Yaounde Gynaeco-Obstetrical and Paediatric Hospital , Yaounde, Cameroon
                [5 ] Department of Surgery , Douala Gynaeco-Obstetrical and Paediatric Hospital , Douala, Cameroon
                [6 ] Faculty of Health Sciences , University of Buea , Buea, Cameroon
                Author notes
                Correspondence address. Department of Surgery, Mbouo Protestant Hospital, Faculty of Medecine and Biomedical Sciences of the University of Yaounde I, Yaounde, Cameroon. Tel: (+237) 698084255/670898130; E-mail: mbessohulrich@ 123456yahoo.com
                Article
                Publisher ID: rjaa232
                DOI: 10.1093/jscr/rjaa232
                PMC ID: 7371009
                SO-VID: 53f8c6ca-1a0c-4c06-acbb-88375714e202
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 20 May 2020
                Date revision received : 12 June 2020
                Date accepted : 3 July 2020
                Page count
                Pages: 4
                Categories
                Subject: AcademicSubjects/MED00910
                Subject: jscrep/0160
                Subject: Case Report

                Data availability:

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