A rare cause of reversible gastric outlet obstruction

Excerpt

A 45-year-old male presented with abdominal pain‚ recurrent post-prandial vomiting and progressive weight loss of 6-week duration. Gastroscopy revealed luminal narrowing of proximal second part of duodenum and endoscopic biopsies from stomach and narrowed site were non-contributory. Ultrasound abdomen revealed diffusely enlarged sausage-shaped hypoechoic body and tail of the pancreas with diffusely narrowed main pancreatic duct with hyperechoic walls (Fig. 1a). Also, hypoechoic pancreatic tissue was seen encircling hyperechoic narrowed second part of duodenum (Fig. 1b). Computed tomography (CT) revealed dilated stomach and first part of duodenum and diffusely enlarged sausage-shaped pancreas (Fig. 1c). The second part of the duodenum was narrowed and surrounded by pancreatic tissue (Fig. 1d). Hypodense areas were seen in bilateral renal cortex (left > right) (Fig. 1c, d). Endoscopic ultrasound (EUS) revealed diffusely enlarged pancreas with parenchymal lobularity. Also, diffuse symmetrical thickening of bile duct as well as cystic duct wall was seen (Fig. 1e).

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