Truncal vagotomy with gastrojejunostomy
Gastric outlet obstruction is manifested by obstruction at the level of the pylorus, which is the outlet of the stomach. Patients may develop vomiting, which may be projectile but non-bilious in nature, nausea or abdominal pain. An unusual finding that may lead to the diagnosis is the succussion splash, a splash-like sound heard over the stomach in the left upper quadrant of the abdomen on shaking the patient, with or without the stethoscope.
The diagnosis is typically made by X-ray, which will show an absent air bubble in the stomach, or by CT scan.
Causes of gastric outlet obstruction include peptic ulcer disease; tumours of the stomach, including adenocarcinoma (and its linitis plastica variant), lymphoma, and gastrointestinal stromal tumours; infections, such as tuberculosis; and infiltrative diseases, such as amyloidosis.
Metabolic alkalosis may develop as a result of loss of acid.
Traditionally severe cases of Gastric outlet obstruction are treated usually by a gastroenterostomy rather than a pyloroplasty. Truncal vagotomy leads to reduction of the maximal acid output by 50% as vagus nerves are sectioned which critically controls the secretion of gastric acid.