Asian Journal of Case Reports in Surgery

Background: This case report discusses our experience of managing a case of metal key ingestion with incidentally detected gastric outlet obstruction by trial of endoscopy followed by surgery.

Presentation of Case: A case of 21 years old male prisoner presented with 2 days history of ingestion of metallic key and postprandial vomiting with history of mild abdominal distension and upper abdominal pain with no previous significant history. Clinical examination was unremarkable. Patient was kept nil per orally and serial Xray were taken which showed movement of foreign body following which CT abdomen and pelvis was done due to doubtful location in Xray. In CT over distended stomach measuring approximately 25 x 10 cm with metallic foreign body 4x2 cm noted in the stomach following which patient was posted for endoscopic retrieval of foreign body. In endoscopy, food stasis was noted in stomach with pinpoint pylorus, scope couldn’t be negotiated beyond pylorus, key couldn’t be visualised. Due to repeated vomiting and abdominal pain, patient was planned for emergency operation and underwent gastrotomy with key retrieval with gastrojejunostomy with truncal vagotomy with feeding jejunostomy. Patient had an uneventful recovery and was discharged on post operative day 25.

Discussion: Late-onset pyloric stenosis is due to the persistence of the infantile form, which becomes clinically evident only at a later stage, when a triggering event,like foreign body ingestion resulting  inflammation, edema, or spasms, which precipitates pyloric occlusion [1]. Acute inflammation of pylorus can lead to gastric outlet obstruction manifested by early satiety, anorexia, weight loss, nausea, vomiting. In chronic inflammation, stomach can become massively dilated and lose its muscular tone. 12% of patients with peptic ulcer presented with gastric outlet obstruction as a direct consequence of a pyloric canal ulcer with associated pylorospasm [2].

Conclusion: Asymptomatic presentation of gastric outlet obstruction is rare, and hence, should be kept in mind in such situations of retained foreign body where it can cause acute inflammation and exacerbate gastric outlet obstruction.