A 45-year-old man with a peptic ulcer perforates and undergoes emergency laparotomy. A 1.5 cm anterior duodenal perforation is found and repaired with an omental patch (Graham's patch). Three weeks later he presents with early satiety and vomiting of undigested food. The MOST likely diagnosis is:
- A Gastric outlet obstruction due to duodenal oedema/fibrosis ✓
- B Delayed gastric emptying from vagal injury during surgery
- C Roux-en-Y anastomotic stricture
- D Recurrent peptic ulcer perforation
Explanation
After omental patch repair of a duodenal ulcer perforation, gastric outlet obstruction (GOO) can develop due to post-inflammatory oedema, adhesions, or fibrosis at the pyloro-duodenal junction — especially if the patient had a pre-existing chronic ulcer with scarring. Vomiting of undigested food (non-bilious, high-volume) 3 weeks post-repair is classic for GOO. Vagal injury would produce delayed gastric emptying with more gradual symptoms and typically absence of large food residue. Roux-en-Y anastomosis was not performed. Re-endoscopy and balloon dilation or pyloroplasty/gastrojejunostomy are treatment options.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.