Gastric outlet obstruction secondary to adult gastric antral web

The gastric antral mucosal diaphragms also called gastric antral webs (GAW) are circumferential membranes of mucosa and submucosa with a central aperture that occur in the gastric antrum near the pyloric canal [1]. They form a rare cause of gastric outlet obstruction (GOO) in adults [2,3]. A 45-year-old well-nourished male presented with postprandial epigastric pain, bloating, fullness and belching since childhood. He had borborygmi and crampy pain postprandially for several hours after which fullness and pain was relieved. He reported intermittent exarcerbations with repeated vomiting containing undigested food taken several days before with recent increase in frequency of episodes. He had undergone an endoscopy a year back reporting a prepyloric ulcer with pyloric stenosis and was treated conservatively with not much improvement. An endoscopy revealed GOO with a very small opening of the pylorus, not negotiable with the scope (Fig. 1). A contrastenhanced computed tomography demonstrated normal but overdistended stomach, showing abrupt cutoff just proximal to pylorus, with normal caliber pylorus and duodenum without any lesion or thickening but showed some contrast indicating incomplete obstruction (Fig. 2). A diagnosis of pyloric obstruction secondary to healed prepyloric ulcer was made. At laparotomy there was no scarring of antrum, pylorus or duodenum. On pyloroduodenotomy the obstruction was found to be because of a GAW immediately juxtapyloric in position. After dividing the web, a pyloroplasty was completed. Post surgery patient’s symptoms resolved with normal imaging. The etiology of GAWs is agreed to be congenital in infants and children whereas in adults, whether it is congenital or acquired is controversial [4]. Approximately one fourth of all reported cases is associated with either gastric or duodenal ulcer disease, possibly caused by scarring of linear circumferential prepyloric and pyloric ulcers [4,5]. LETTERS TO THE EDITOR