A clinical study of gastric outlet obstruction
DOI:
https://doi.org/10.18203/2349-2902.isj20164453Keywords:
Gastric outlet obstruction, Paralytic ileus, RecoveryAbstract
Background:From the standpoint of pathology, the term pyloric stenosis is usually inaccurate at least in adult patients, since the site of obstruction is rarely situated at the pylorus itself but, is more often placed immediately proximal to the spinchter where the diagnosis of carcinoma is most probable or more distally in the duodenal bulb where the cause is almost invariably a duodenal ulcer. The aim was to study infantile hypertrophic pyloric stenosis, benign peptic ulcer and gastric carcinoma and evaluation of electrolyte abnormalities in gastric outlet obstruction, to study various modalities of treatment and to assess pertaining to recovery from paralytic ileus.
Methods: This was a clinical observational study comprising of 40 cases of gastric outlet obstruction. The patients for this study have been selected from Prathima Institute of Medical Sciences, Karimnagar, Telangana, India from December 2013- November 2015. The cases were selected who were willing to undergo surgery.
Results:Congenital hypertrophic pyloric stenosis (CHPS) is more common among first born male infants. Parental consanguinity is associated with increased incidence of congenital hypertrophic pyloric stenosis. CHPS is common in the age group of first 3-6 weeks of life (average 4 weeks). Males are more commonly affected with gastric outlet obstructions in adults. Cicatrized duodenal ulcer is more common in the age group of 30-40 years, while carcinoma stomach is more common in age group of 50-60 years. Vomiting and visible gastric peristalsis are the most common and constant symptom and sign of gastric outlet obstruction, more so in cases of cicatrized duodenal ulcers.
Conclusions:Ramstedt’s pyloromyotomy is the gold standard treatment for CHPS. Patients with gastric outlet obstruction due to cicatrized duodenal ulcer require truncal vagotomy with posterior gastrojejunostomy. Vagotomy is optional in view of better response with drugs for APD. Antral carcinoma cases require curative or palliative surgery depending on the stage of the disease.
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References
Ellis H, Pyloric stenosis In: Nyhus LM, Wastell C, editors. Surgery of the stomach and duodenum, 4th Ed. Little Brown Publications, Boston, 1986:475.
Swenson. Pyloric stenosis In: Raffenssperger GJ, Ed. Swenson’s Paediatric Surgery 5th ed. 1990;211-9.
Gibba MK, Herden V. Mayo clinic proc-50:312,1971.
Benson CD, Mustard WT, Ravich MM. Congenital pyloric Stenosis. Paediatr Surg. 1962;2:670-4.
Spicer RD. Infantile hypertrophic pyloric stenosis:a review. Br J Surg. 1982;69:128-35.
Alexander HR, Kelsun DP, Tepper JE. Cancer of the Stomach, In: Vincent T. Devita Jr, Hellman S, Rosenberg SA, Ed(s), Cancer: Principles and practice of oncology, 6th Ed. Lippincott Williams and Wilkins, Philadelphia, 2001:1092.
Fisher DR, Ebert PA, Zenidena GD. Obstructing peptic ulcers results of treatment. Arch Surg. 1967;94:724-9.
Yogiram B, Choudhary NVS. Duodenal (ulcer) stenosis in Andhra Pradesh: a ten year study. Indian J Surg. 1983;12:3.
Kozoll DD, Meyer KA. Obstructing gastroduodenal ulcers: Symptoms and signs. Arch Surg. 1964;89:491.
Schwartz ML, Humphry WE, Dunn HD, Weiland Douglas. Gastric outlet obstruction in peptic ulcer disease, an indication for surgery. Am J Surg. 1982:143:90.
Ralph A. Vagotomy and drainage for obstructing duodenal ulcers. Am J Surg. 1974;127:237.
Bailey RW. Laparoscopic management of peptic ulcer disease. Surgical Laparoscopy Update, Quality Medical Publishing, Missouri, 1993:241.
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