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JAMA Surgery Clinical Challenge
June 2016

Gastric Outlet Obstruction

Author Affiliations
  • 1Department of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, the Netherlands
  • 2Erasmus MC, University Medical Center Rotterdam, Department of Hepatobiliary and Pancreatic Surgery, Rotterdam, the Netherlands
JAMA Surg. 2016;151(6):577-578. doi:10.1001/jamasurg.2016.0232

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.