Gastric outlet obstruction in adults in the University of Benin Teaching Hospital: A 5-year prospective study

Abstract

Background: Gastric outlet obstruction (GOO) is a contemporary surgical challenge. It is due to mechanical pyloroduodenal obstruction of gastric emptying. In Africa, cicatrizing duodenal ulcer or antral tumors are common causes; resultant inanition, fluid, electrolyte, and nutritional derangements could be life-threatening. Definitive therapy aims at relieving the obstruction. Aim: To highlight causes, clinical features, and outcome of management of GOO in the University of Benin Teaching Hospital. Patients and Methods: This was a 60-month prospective study from July 1, 2013, to June 30, 2018. Consecutive adult patients with GOO were studied. Diagnosis was confirmed using barium meal, esophago-gastro-duodenoscopy, biopsy, and operative findings. Preoperative optimization required nasogastric tube suctioning/warm saline lavage, intravenous fluids, antibiotics, and blood transfusion. Results: There were 52 GOO patients, constituting 7.9% of 659 gastrointestinal conditions requiring surgery during the study period. Operative intervention occurred in 50 (96.2%) patients. The male:female ratio was 1.7:1. The age ranges from 32 to 89 years, with a mean age of 63.5 ± 15.3 years. Most patients were in the 7th-8th decades of life (33 patients, 63.5%). Nonbilous vomiting and epigastric pain occurred in 50 (96.2%) patients, while 49 (94.2%) patients had weight loss. Mean duration of symptoms 10.5 ± 12.1 weeks. Malignant obstructions were 63.5% (33 patients). Palliative by-pass was effected in 58.0% (29 patients). Hospital stay was 16–23 days. Mortality rate was 3.8% (2 patients). Conclusions: GOO is a disease of the elderly in our region. Presentation is late. Most require surgical intervention. The most common cause is malignant obstruction. Most patients require prolonged, adequate preoperative resuscitation/optimization. We advocate early referral, routine endoscopy, and biopsy for patients with epigastric pain in the subregion.