Gastric outlet obstruction in a 12 year old male

Abstract

Pyloric stenosis presenting beyond infancy is uncommon and poorly understood. Here, we present a case of primary acquired gastric outlet obstruction due to pyloric stenosis in a 12-year-old male child. The patient presented after a four-year history of persistent non-bilious, post-prandial emesis and failure to thrive. A Heineke-Mikulicz pyloroplasty was performed. Pyloric biopsy was without diagnostic abnormality. A gastrostomy tube was also placed at the time of pyloroplasty. The patient was asymptomatic after surgery and had gained 25 pounds after three and a half months. The gastrostomy tube was removed 4 months after the pyloroplasty. Literature review yielded 42 cases, including the current report, of patients ages 4 months to 17 years with a diagnosis of primary acquired gastric outlet obstruction. Useful studies for diagnosis of these cases include abdominal ultrasound, upper GI contrast study and esophagogastroduodenoscopy. The most common curative procedure reported in the literature was a pyloroplasty (31 cases). The remaining patients underwent Bilroth I gastrectomy (7 cases), balloon dilatation (3 cases) and pyloromyotomy (1 case). Keywords: Gastric outlet obstruction, Pyloric stenosis, Pyloroplasty, Failure to thrive, Adolescence, Eosinophilic esophagitis