GASTRIC OUTLET OBSTRUCTION - GOO

Gastric Outlet Obstruction (GOO) or Congenital Pyloric Stenosis is a condition where the outlet from the stomach, the pylorus, is blocked and the food cannot pass through to the duodenum (the small bowel). It is usually caused by scarring of the pyloric region (gastric outlet) due to peptic ulcer disease (PUD). Sometimes a tumor, most often malignant, causes the obstruction.

Typically the patient suffers from repeatedly vomiting of old undigested food eaten many hours before. Usually the patient is meager and dehydrated.

 patient-preoperatively

 

The diagnosis is confirmed by the presence of visible gastric peristalsis and ventricular splash.

Ventricular peristalsis  ← click for video

 Ventricular splash  ← click for video

 

X-ray after a barium meal will show delayed emptying of the stomach, and often the contour of the stomach will be seen deep in the pelvis. 

 barium-meal-1

 barium-meal-2

 

Draining the stomach with a naso-gastric tube (NG tube) will produce thick muddy content (undigested food).   

 ng-tube-1

 ng-tube-4

 

When caused by pyloric scarring due to Peptic Ulcer Disease a Gastrojejunostomy & Truncal Vagotomy (anastomosis between the stomach and small intestine with cutting off the acid producing Vagus nerve) is done.

When caused by a tumor a Ventricular Resection (removal of part of the stomach) is done