Gastric outlet obstruction in carcinoma gall bladder.

BACKGROUND: Gastric outlet obstruction is occasionally reported to occur in advanced gall bladder malignancy and may require palliative surgery. A review of 39 patients who required gastroenterostomy for symptomatic or incipient gastric outlet obstruction in carcinoma gall bladder is presented. METHODS: This retrospective review included 24 women and 15 men over nine years who underwent gastrojejunostomy for locally advanced neoplasms of the gall bladder. RESULTS: Twenty two patients with carcinoma gall bladder had symptomatic gastric outlet obstruction whereas in 17 patients gastrojejunostomy had been performed for intraoperatively assessed impending obstruction. Thirty-four patients had concomitant jaundice. In most cases, there was obstruction of the first two parts of the duodenum, mostly by direct tumoral infiltration (64%). All patients underwent anterior gastrojejunostomy, with billoenteric bypass in 15 patients. There were two postoperative deaths. Eight patients developed postoperative delayed gastric emptying; all settled on conservative management, though two patients had recurrent refractory vomiting. Thirty patients had no vomiting till a follow up ranging from 36 days to 11 months. CONCLUSIONS: Gastric outlet obstruction may frequently complicate gall bladder cancer and a satisfactory palliation can be achieved in most patients by gastrojejunostomy.