Gastric Outlet Obstruction

Neelam Maurya

7 years ago

Gastric outlet obstruction (GOO, also known as pyloric obstruction)

Anatomy

The stomach is located mainly in the left upper quadrant beneath the diaphragm and is attached superiorly to the esophagus and distally to the duodenum.
The stomach is divided into four portions: cardia, body, antrum, and pylorus.
Inflammation, scarring, or infiltration of the antrum and pylorus are associated with the development of GOO.

Patients present with intermittent symptoms that progress until obstruction is complete.
Vomiting is the cardinal symptom.
Initially, patients may demonstrate better tolerance to liquids than solid food.
In a later stage, patients may develop significant weight loss due to poor caloric intake.
Malnutrition is a late sign, but it may be very profound in patients with concomitant malignancy.
In the acute or chronic phase of obstruction, continuous vomiting may lead to dehydration and electrolyte abnormalities.
In gastric outlet obstruction in a peptic ulcer patient the site of obstruction is most likely to be duodenum.

The major benign causes of GOO are

PUD, gastric polyps, ingestion of caustics, pyloric stenosis, congenital duodenal webs, gallstone obstruction (Bouveret syndrome), pancreatic pseudocysts, and bezoars.