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gastric outlet obstruction (pyloric stenosis)
Etiology:
1) peptic ulcers situated close to the pyloric channel
2) advanced gastrointestinal cancer
- gastric cancer, duodenal cancer, or pancreatic cancer
3) also see hypertrophic pyloric stenosis
Epidemiology:
- 5% of patient with peptic ulcer
Clinical manifestations:
- nausea/vomiting
Laboratory:
1) hypokalemia may occur
2) metabolic alkalosis may be present
3) evidence of dehydration may be present
Radiology: in
- plain abdominal film often shows dilated stomach with air- fluid level
Management:
1) nasogastric suction for at least 72 hr to decompress the stomach
2) hydrate
3) correct hypokalemia
4) endoscopic dilatation
a) endoscopically placed stainless steel stents can palliate obstructive symptoms, failure is frequent due to migration or obstruction
b) newer nickel titanium (nitinol) self-expandable stent placed through the endoscope channel under fluoroscopic guidance may be of benefit [2]
5) surgical correction
Specific
hypertrophic pyloric stenosis (IHPS, HPS)
General
gastric disease
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 344
- van Hooft JE et al.
Efficacy and safety of the new WallFlex enteral stent in
palliative treatment of malignant gastric outlet obstruction
(DUOFLEX study): A prospective multicenter study.
Gastrointest Endosc 2009 May; 69:1059.
PMID: 19152912