Emergency Surgery following Gastric Outlet Obstruction Incited by Chronic NSAID Use
Location
Moultrie, GA
Start Date
4-5-2022 1:00 PM
End Date
4-5-2022 4:00 PM
Description
Known causes of acquired gastric outlet obstruction (GOO) include acid ulcer disease and chemical irritants, particularly non-steroidal anti-inflammatory drugs (NSAIDs). Complications of gastric outlet obstruction include acute gastric dilatation and ulcer perforation. Here, we present a case of chronic intermittent gastric outlet obstruction due to NSAIDs overuse leading to antral peptic ulcer with perforation in a malnourished 35 year old woman. The patient presented to the emergency department complaining of acute abdominal pain with a 4-year history of severe anemia requiring transfusions, and 1 year-long history of postprandial pain, nausea, bilious vomiting and NSAIDs overuse with a reported unintentional 30 pound weight loss in the last 6 months. Initial imaging in the emergency department demonstrated severe gastric dilatation extending into the pelvis, with evidence suggesting a peptic ulcer with perforation. Following prompt nasogastric decompression, an emergent exploratory laparotomy with subsequent Billroth I reconstruction and feeding jejunostomy tube placement was performed. The postoperative course was complicated with septic shock within the first 24 hours after surgery, however, the remainder of the inpatient course was uneventful with discharge on postoperative day 10. The patient was asymptomatic throughout the outpatient postoperative period with reported weight gain and discontinued NSAIDs use. The feeding jejunostomy tube was inadvertently removed prematurely at approximately 30 days after placement without adverse consequence. Relevant literature addressing contributory factors to NSAIDs overuse and social determinants of health will also be presented.
Embargo Period
5-31-2022
Emergency Surgery following Gastric Outlet Obstruction Incited by Chronic NSAID Use
Moultrie, GA
Known causes of acquired gastric outlet obstruction (GOO) include acid ulcer disease and chemical irritants, particularly non-steroidal anti-inflammatory drugs (NSAIDs). Complications of gastric outlet obstruction include acute gastric dilatation and ulcer perforation. Here, we present a case of chronic intermittent gastric outlet obstruction due to NSAIDs overuse leading to antral peptic ulcer with perforation in a malnourished 35 year old woman. The patient presented to the emergency department complaining of acute abdominal pain with a 4-year history of severe anemia requiring transfusions, and 1 year-long history of postprandial pain, nausea, bilious vomiting and NSAIDs overuse with a reported unintentional 30 pound weight loss in the last 6 months. Initial imaging in the emergency department demonstrated severe gastric dilatation extending into the pelvis, with evidence suggesting a peptic ulcer with perforation. Following prompt nasogastric decompression, an emergent exploratory laparotomy with subsequent Billroth I reconstruction and feeding jejunostomy tube placement was performed. The postoperative course was complicated with septic shock within the first 24 hours after surgery, however, the remainder of the inpatient course was uneventful with discharge on postoperative day 10. The patient was asymptomatic throughout the outpatient postoperative period with reported weight gain and discontinued NSAIDs use. The feeding jejunostomy tube was inadvertently removed prematurely at approximately 30 days after placement without adverse consequence. Relevant literature addressing contributory factors to NSAIDs overuse and social determinants of health will also be presented.