Rare causes of gastric outlet obstruction in children

Abstract

Gastric outlet obstruction (GOO) presenting beyond the newborn period is a relatively rare condition, when infantile hypertrophic pyloric stenosis (IHPS) is excluded. This report describes the clinical features, evaluation and management of 18 patients with GOO which was not caused by IHPS. The sex, age, and main presenting features were recorded on admission. Hemoglobin estimation, serum chemistry and blood gas analysis were also assessed in these patients. The diagnosis was confirmed with gastrointestinal barium, B ultrasound, gastroscopy, or at surgery. Some of them underwent gastroscopy with biopsy sampling for rapid urease test or histologic examination with Giemsa stains for Helicobacter pylori. Thirteen patients had peptic ulcer disease, of which six were successfully treated with medications. While the other seven needed operative management which included Heineke-Mikulicz pyloroplasty, gastroduodenostomy or gastrojejunostomy, respectively. All the patients who had Heineke-Mikulicz pyloroplasty or gastrojejunostomy developed bile reflux gastritis that could be alleviated with omeprazol. None of the patients developed dumping syndrome, failing to thrive, or anemia. Three children with antral diaphragm recovered without any complications by diaphragm excision with Heineke-Mikulicz pyloroplasty. The pylorus was compressed by fibrotic band in one 30-month boy, and he recovered uneventfully with Heineke-Mikulicz pyloroplasty during 10-year follow-up. Gastric outlet obstruction secondary to ingestion of sulfuric acid was noted in one patient, and he was successfully treated with gastroduodenostomy. Our data suggests that the satisfactory results could be expected in children with GOO with different therapeutic modalities based on the specific cause and degree of obstruction.

Delayed presentation of hypertrophic pyloric stenosis: a rare case

“…Hypertrophic pyloric stenosis usually presents with nonbilious projectile vomiting starting at 2 to 6 weeks of age with a peak at 3 to 5 weeks [2]. With exclusion of congenital HPS, GOO in childhood is a rare condition (1:100,000) [3,4]. We report a case of delayed presentation of HPS at the age of 4 1/2 years.…”

Usual and unusual causes of pediatric gastric outlet obstruction

“…The exact incidence of gastric outlet obstruction in the older child is not well-established [3][4][5][6][7]. One Taiwanese report documents that 11 of 142 patients admitted with gastric outlet obstruction were from non-IHPS causes, including other congenital anomalies and peptic ulcer disease [8].…”

Gastric outlet obstruction in children: an overview with report of “Jodhpur disease” and Sharma's classification

“…The various reported causes of the GOO in the pediatric age group, apart from the IHPS, may be distinguished broadly into 2 groups: the congenital group-aplasia, atresia, and the diaphragms and webs of pylorus and antrum, to which we add the rare intraluminal obstructions like mucosal valves and the aberrant or heterotrophic pancreas; and the acquired group-mainly GOO secondary to acid peptic disease and neoplasia, to which we add a few other rarer causes that are the reported cases of GOO secondary to chemical injury, for example, after ingestion of acid, caustic, and potassium carbonate [12][13][14][15][16][17][18][19].…”