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CASE REPORT
Year : 2017  |  Volume : 37  |  Issue : 2  |  Page : 76-79

Gastric outlet obstruction: Report of an exceptional case


1 Department of Pathology, ESI PGIMSR, Kolkata, West Bengal, India
2 Department of Pathology, Calcutta Medical College, Kolkata, West Bengal, India

Correspondence Address:
Dr. Senjuti Dasgupta
Department of Pathology, Medical College, 88 College Street, Kolkata - 700 073, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmedsci.jmedsci_27_16

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Although gastric outlet obstruction is a common condition, etiology could not be determined in a few cases by means of clinical features, radiological, and endoscopic examination, resulting in substantial diagnostic dilemma. A case is being described where a 30-year-old male presented with anorexia, dyspepsia, vomiting, low-grade fever, and weight loss for 2 months. Results of routine laboratory tests were within normal limit except elevated erythrocyte sedimentation rate. Abdominal computed tomography scan demonstrated a gastric outlet obstruction by an antral mass with mild enhancement of the area. Upper gastrointestinal endoscopy depicted an ulcerated and friable mass with an irregular shape and surface at pylorus resulting in pyloric obstruction. Endoscopic biopsy revealed only chronic gastritis with regenerative changes of epithelium. As the patient was not relieved of obstruction by conservative management, Billroth Type II gastrectomy was done. Histopathological examination of the resected specimen revealed caseating granulomas with acid-fast bacilli. Finally, the patient was diagnosed as primary gastric tuberculosis after exclusion affection of other organs and antituberculous medications was initiated. A good response to antitubercular treatment was noted after 5 months. Stomach being an uncommon site of tuberculosis and as it can occur in patients with no risk factors or characteristic symptoms, diagnosis of such rare condition remains a diagnostic enigma.


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