One patient came to me in great distress with hiccup,pain in the abdomen and inability to stand. Apart from this ,patients present to a doctor with complains of vomiting of stale food some hours or days of taking food.There is loss of appetite ,weakness,malnutrition,hiccup and desire to induce vomiting to get relief from pain.
These are the cardinal symptoms of obstruction to passage of food from stomach called Pyloric obstruction/Duodenal stenosis.Causes are varied.Important common cause are development of stenosis after a benign duodenal or pyloric ulcer,a cancer obstructing the passage from stomach and a foreign body such as leaves or hair ball(eaten) seen in psychotics.After invent of stomach acid suppressing drugs these cases are seldom seen.But the patient in question was a road side vendor with irregular and bad eating habit.The patient said that he is in empty stomach .So to find out the cause in hope of some interesting findings the endoscope was put.
The scope was in stomach as if under a sea .It was initially thought that the patient told a lie though has taken water .But we could not get over the water content and have to wander inside it as if swimming in a pool.Then we started aspirating the contents.The liquid content was thick and coffee colored and chances of blocking the channel of scope was high.We could aspirate about 5 liters of this fluid to see undigested rice particles in the stomach .We stopped there as the stomach wall became visible.My scope 100 cms in length could not reach the last end of stomach called pylorus on which there was a heap of rice blocking further viewing.And consequently could not visualize the obstructing lesion.This is my first case with these finding in my experience of 7 years of endoscopy.
I just remain wondered how the patient was tolerating this.This is nothing but the out come of poverty for which he could not come early.As far as it could be visualized no tumor was found except ulcerations in the upper part of stomach and I presumed it to be a benign obstruction following a long standing duodenal ulcer. But reserved my opinion pending a second endoscopy following a few days of stoppage of oral feeding and remaining on parental feeding.
If this will finally come out to be benign a bypass surgery is required .If malignancy will be found outcome will depend on the stage of disease.Obstruction due to foreign bodies such as leaves called Phytobezoar or by hair called Tricobezoar are to be open removed.