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

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.