D0294 - An Unusual Cause of Gastric Outlet Obstruction

Noelle Provenzano, DO, Yogesh Govil, MD
Einstein Healthcare Network, East Norriton, PA

Introduction: Gastric outlet obstruction (GOO) is often an initial sign of upper gastrointestinal neoplasms causing mechanical obstruction that is characterized by abdominal pain and vomiting. Neoplasms that most often cause GOO include gastric, pancreatic, and biliary tract malignancies. We report an 82-year-old female who presented with nausea, vomiting, and right upper quadrant pain, without urinary symptoms, who was found to have a GOO due to high grade urothelial carcinoma.

Case Description/Methods: An 82-year-old female with no gastrointestinal or urinary history presented with nausea, vomiting and right upper quadrant abdominal pain with no urinary or systemic symptoms. A computer tomography (CT) showed severe right hydronephrosis related to a 3.5 x 2.2 cm ill-defined soft tissue density at the ureteropelvic junction, which extended to the lower pole calyx of the right kidney. The patient left against medical advice and returned five days later due to increasing symptoms. A repeat CT showed increased distention of the stomach secondary to encasement of the duodenum from the neoplasm. Urinalysis was negative for blood, casts, transitional epithelium, and squamous epithelium. A CT urogram showed severe right hydronephrosis secondary to an irregular mass that appeared to infiltrate into the surrounding fat and abutted the duodenum, inferior vena cava and right psoas muscle. An upper endoscopy (EGD) to further evaluate for gastric origin did not find mucosal disease, but it did show a severe extrinsic deformity in the third portion of the duodenum (Figure 1). The patient then underwent a cystoscopy with right retrograde pyelogram and right ureteral stent placement. Unfortunately, her cytology was positive for high grade urothelial carcinoma. Ultimately, the patient felt too weak to proceed with any procedures and chose to transition to hospice care.

Discussion: GOO most often can be caused by infiltrative disease, peptic ulcer disease, gastric polyps, and malignancy. Upper tract urothelial carcinoma represents 5% of urothelial cancers with few cases causing GOO reported. Although this patient did not present with hematuria of flank pain, this case highlights, patients presenting with intractable vomiting or abdominal pain should undergo imaging.



Disclosures:


Noelle Provenzano, DO, Yogesh Govil, MD. D0294 - An Unusual Cause of Gastric Outlet Obstruction, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.