Duodenal carcinoid - A very rare cause of gastric outlet obstruction ( Duodenography-old is gold), with review of literature.

摘要

Acquired gastric outlet obstruction (GOO) by a duodenal carcinoid is a very rare condition. We report an unusual case of 21 year old female who presented with epigastric fullness and postprandial upper abdominal distention of two and a half year duration and recurrent non bilious vomiting and progressive weight loss of two months duration. Confirmatory preoperative diagnosis was not available. The case was diagnosed as carcinoid postoperatively after pathologic examination. We are reporting this case because of its rarity and with excellent outcome if diagnosed and managed properly. Even on extensive search of medical literature we are not able to find report of such a lesion causing features of gastric outlet obstruction. Case report A 21-year old female was referred to our teritiary care hospital from a peripheral centre for management of epigastric fullness and postprandial upper abdominal distention of two and a half year duration and recurrent non bilious vomiting and progressive weight loss of two months duration. Her past surgical history consisted of appendicectomy performed two years back for right iliac fossa pain.On admission, the girl was emaciated, weighed 45 Kgs. She had gross pallor. Abdominal examination revealed epigastric distention and a tympanic mass in the epigastric area was appreciated. Bowel sounds were sluggish and per-rectal examination revealed nothing significant. Her herniated orifices were normal.Her blood investigations were unremarkable except for a total leukocyte count count (TLC) of 17.06x106. Her serum amylase level was normal. Plain X-ray abdomen showed features of a distended stomach. Ultrasonography (USG) abdomen was normal. Upper GI endoscopy was done which was in favour of a duodenal tumour (in the second part, likely a gastro intestinal stromal tumour). Barium study (duodenography) of upper GI tract revealed a well circumscribed filling defect in contrast filled duodenum. The patient underwent elective laparotomy. Duodenotomy (in second part of duodenum) and sub mucous resection of duodenal tumour (located on posteromedial wall) was done. The specimen was sent for pathologic examination which showed the tumour to be carcinoid. The patient became symptom free and was discharged on 7th postoperative day. At 4? month follow up, she is free of any symptom and thriving well. The patient has also undergone upper GI endoscopy and USG abdomen twice since then, and shows no recurrence till date.