Massive gastric dilatation in outlet obstruction – is it always benign?

Abstract

Gastric outlet obstruction is one of the most common clinical presentations of carcinoma of the stomach, especially in South-West Asia. Although gross gastric dilatation is common in benign obstruction of the pylorus due to peptic ulcer disease, a hugely dilated and distended stomach can be a very rare presentation in a patient with malignancy. A 65-year-old female patient presented with recurrent episodes of vomiting immediately after food, ball-rolling movements in the abdomen, and loss of appetite and significant weight loss in the past 1 month. Upper gastrointestinal endoscopy revealed a dilated stomach and an ulceroproliferative growth in the antropyloric region. A biopsy of the growth revealed moderately differentiated adenocarcinoma of the stomach. Contrast-enhanced computed tomography of the abdomen and pelvis showed proliferative growth at antrum and the hugely dilated stomach reaching up to the pelvis. The patient underwent exploratory laparotomy. Intraoperative findings were that of a dilated and thickened stomach with growth at the antropyloric region of the stomach. Metastatic omental deposits were also seen, and thus, palliative gastrojejunostomy was carried out. This case is being reported to highlight that occasionally malignant gastric outlet obstruction may lead to a massive dilatation of the stomach.