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 21 March 2018

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GastroenterologyStomach & duodenum

Peptic ulcer

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Peptic ulcer disease - total gastric outlet obstruction.

A 58-year old man with a two-week history of feeling unwell, bloated and recent onset of vomiting. For the previous 12 months he had noticed a 'full' feeling after meals. He used to suffer with abdominal pain, for which he took a painkiller. He had never been treated for peptic ulcer disease, or taken antacid medications.
The patient had a succussion splash, and a grossly distended stomach was visible on the plain abdominal radiograph. A nasogastric tube was passed and drained only 500 ml of thick soupy material. Minimal drainage over the following two days and the stomach could only be emptied after the passage of a 36Fr oro-gastric lavage tube. Three litres of material were drained. An endoscopy then showed a totally occluded pylorus. Unable to get a guide wire into the pylorus. The endoscopy photograph shows some food remnants and an area of bleeding where some blind pyloric channel biopsies were taken.
With today's effective pharmacotherapy for peptic ulcer disease, total gastric outlet obstruction is a rare complication.
Peter Devitt, Adelaide, Australia

Peptic ulcer disease - total gastric outlet obstruction.

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