Gastric Outlet obstruction (pyloric stenosis) in Adults
🚫🍲 Severe gastric outlet obstruction (GOO) in adults is a serious condition.
🔎 Always exclude functional/non-mechanical causes (e.g. diabetic gastroparesis).
⏱️ Prompt diagnosis & intervention are essential to prevent complications.
| ⚠️ Severe Gastric Outlet Obstruction (Pyloric Stenosis) in Adults |
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- 🔬 Causes: Gastric, pancreatic, lymphoma, metastatic cancer; benign causes such as peptic ulcer disease.
- 🫁 ABC + IV fluids (replace K⁺) ➝ common dehydration + hypokalaemia from vomiting.
- 🚫 Nil by mouth + 🧴 NG Tube decompression to relieve distension and stop vomiting.
- 🍽️ Nutrition: Consider jejunostomy feeding if prolonged, or TPN if enteral fails.
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ℹ️ About
- Historically caused by benign peptic ulcer scarring ➝ now most commonly malignant in adults (gastric/pancreatic).
🩺 Causes
- 🎗️ Malignancy ➝ pancreatic, gastric, duodenal, ampullary, cholangiocarcinoma.
- 🌀 Chronic PUD scarring/stenosis with H. pylori.
- 🍏 Foreign body ➝ bezoars.
- 👶 Congenital pyloric stenosis (babies).
👨⚕️ Clinical
- 🤢 Vomiting post-prandially (non-bilious).
- 🔥 Dyspepsia in background of ulcer disease.
- ⚖️ Weight loss, cachexia.
- 🩺 Succussion splash >4 hrs after eating.
🔬 Investigations
- 🧪 FBC ➝ anaemia. U&E ➝ dehydration/AKI.
- ⬇️ K⁺, ⬇️ Cl⁻, ⬆️ HCO₃⁻ ➝ metabolic alkalosis.
- 🚽 Paradoxical acidic urine (despite alkalosis).
- 📸 AXR ➝ distended stomach + air-fluid levels.
- 🧴 NG aspirate ➝ >200mls after overnight fast.
- 🥛 Barium swallow ➝ delayed emptying, localise obstruction.
- 📹 Endoscopy ➝ direct visualisation + biopsy if malignancy suspected.
- 🖥️ CT Abdomen ➝ staging, tumour or external compression.
🛠️ Management
- 💧 IV fluids & electrolyte correction (replace K⁺, Cl⁻).
- 💊 PPI + H. pylori eradication if ulcer-related.
- 🔪 Benign: Pyloroplasty or partial gastrectomy if fit.
- 🌉 Malignant: Gastrojejunostomy (bypass) or self-expanding metal stent.
- 🎗️ Oncological ➝ chemo/radiotherapy if tumour-related.
Case – Adult gastric outlet obstruction (pyloric stenosis)
A 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 (vomiting) and AKI stage 1; CXR is clear. Initial management is NBM, large-bore NG tube decompression, aggressive IV fluids with potassium and chloride repletion, and PPI. CT abdomen (contrast) suggests distal gastric narrowing; OGD confirms antral/pyloric stricture with biopsies to exclude malignancy (common adult causes: gastric cancer, pancreatic cancer, less often peptic-ulcer scarring). After resuscitation, options include endoscopic balloon dilation/stenting for benign disease or palliation, versus surgical bypass or resection guided by MDT and staging.
