A 72-year-old woman presented with a 6-month history of a dull, epigastric pain, 10-kg weight loss (from 52 kg to 42 kg), and a 6- to 8-week history of nausea and vomiting. Physical examination showed no notable abnormalities. Blood test results revealed anemia (hemoglobin 9.8 g/dL [to convert to grams per liter, multiply by 10]) but were otherwise unremarkable. Upper gastrointestinal series showed subtotal occlusion in the second part of the duodenum (Figure 1 A). Computed tomography of the abdomen confirmed intraluminal narrowing of the duodenum without signs of a mass (Figure 1 B, arrowhead). Gastroduodenoscopy revealed a duodenal ulcer with pinpoint stenosis that could not be passed or dilated. Multiple biopsies were negative for cancer. Total parenteral nutrition was started and the patient was scheduled for surgery.
de Meijer VE, van Eijck CHJ, Groot Koerkamp B. Gastric Outlet Obstruction. JAMA Surg. 2016;151(6):577-578. doi:10.1001/jamasurg.2016.0232