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Case Reports
. 2025 Feb:127:110882.
doi: 10.1016/j.ijscr.2025.110882. Epub 2025 Jan 14.

Gastric outlet obstruction in an 11-year-old girl due to a pyloric diaphragm - A case report and a systematic literature review

Omran Janoud  1 , Talal Abou Moughdib  2 , Majd Hamed Nasser  2 , Obaida Abo Fakher  2 , Rani Saab  2 , Houssain Al-Halabi  2
Affiliations
Case Reports

Gastric outlet obstruction in an 11-year-old girl due to a pyloric diaphragm - A case report and a systematic literature review

Omran Janoud et al. Int J Surg Case Rep. 2025 Feb.

Abstract

Introduction: Congenital pyloric web or diaphragm are rare causes of Gastric Outlet Obstruction (GOO) after infancy, representing approximately 1 % of gastrointestinal obstructions. While it typically presents in the neonatal period with nonbilious vomiting, delayed diagnosis beyond infancy is exceptionally rare.

Presentation of the case: An 11-year-old girl with presented with one-month history of postprandial vomiting. Her medical history was unremarkable and clinical examination and laboratory investigations were normal. A barium meal X-ray revealed narrowing at the gastric outlet. Endoscopy showed severe pyloric narrowing with undigested food in the stomach. Due to the severity of the stenosis, the endoscope could not traverse and surgical intervention was required.

Discussion: Pyloric webs and diaphragms are considered rare causes of congenital GOO. Confirmation of the diagnosis requires an upper contrast study or endoscopy. Gastric outlet obstruction can manifest with various symptoms. The clinical onset varies depending on the underlying cause. We conducted a systematic literature review of all case reports and series focused on GOO patients over 10 years old due to webs or diaphragms. The review reveals that symptoms are varied and may persist for years before diagnosis due to the rarity of these anomalies and their nonspecific presentations. This review highlights the importance of follow-up period after treatment due to the risk of recurrence.

Conclusion: This case emphasizes the importance of conducting endoscopy or abdominal X-rays with barium meals in evaluating persistent gastrointestinal symptoms, particularly in female patients.

Keywords: Gastric outlet obstruction; General surgery; Pyloric diaphragm.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Barium upper gastrointestinal series illustrating the pyloric diaphragm with a stenotic opening (Indicated by the arrows).
Fig. 2
Fig. 2
Intraoperative image depicting the insertion of a tube to assess the degree of stenosis; the tube (indicated by the arrow) was unable to traverse the stenosis.
Fig. 3
Fig. 3
Image of the stomach demonstrating the closure of the longitudinal gastrotomy utilizing Heineke-Mikulicz pyloroplasty (indicated by the arrow).
See this image and copyright information in PMC

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