A rare cause of gastric outlet obstruction

Gastric outlet obstruction is the clinical and pathophysiological consequence of any disease process that produces mechanical impediment to gastric emptying. It may be acute from inflammatory swelling and peristaltic dysfunction or chronic from cicatrix. Chronic inflammation of the duodenum may lead to recurrent episodes of healing followed by repair and scarring ultimately leading to fibrosis and stenosis of the duodenal lumen. We would like to present a unique case of an elderly lady presenting with intractable vomiting over 3 months, gradually progressive which aggravated on consuming solids initially to consuming liquids later. After thorough investigations a provisional diagnosis of chronic duodenal ulcer with gastric outlet obstruction probably due to cicatrix was made. On laparotomy there was a chronic scarred duodenal ulcer following a previously contained perforation which was causing the gastric outlet obstruction. Cholecystectomy, duodenoplasty and loop gastrojejunostomy was performed with no complications post-operatively. This is a rare case of previous contained duodenal perforation causing gastric outlet obstruction.

Trial using multiple micronutrient food supplement and its effect on cognition.

OBJECTIVE: To test the efficacy of a multiple micronutrient food supplement (MMFS) on the nutrition status of school children and its effect on cognition. METHODS: A MMFS was developed containing chelated ferrous sulphate and microencapsulated vitamin A, B2, B6, B12, folic acid, niacin, calcium pantothenate, vitamin C, vitamin E, lysine and calcium and the efficacy of the MMFS was assessed in 7-11 year old school children in Chennai, India by a pre-post test design. In the experimental group (N=51), the food in the school kitchen was cooked with the MMFS for the residential school children for a period of one year. The control group (N=72) consisted of day scholars who did not eat at the school. Hemoglobin, red blood cell count and hematocrit were measured at baseline and at the end of the study (after one year). A battery of 7 memory tests (The personal information test, the Mann-Suiter Visual memory screen for objects, The digit span forward test, The digit span backward test, The delayed response test, The Benton Visual Retention Test and The Cattells retentivity test), one test for attention and concentration (Letter cancellation test) and one test for intelligence (Ravens's coloured progressive matrices) were administered to all the children at baseline and endline. RESULTS: It was seen that there was a significant (P<0.05) improvement in the experimental group in hemoglobin, hematocrit and red cell count whereas in the control group there was a statistically significant decline(P<0.05) in hemoglobin and red cell count. In 5 tests out of the 7 memory tests and in the letter cancellation test for attention, the mean change in scores in the experimental group is significantly more (P<0.05) than the control group. There was no significant improvement in the overall intelligence as seen in the Ravens progressive matrices between the experimental and control groups at endline. CONCLUSION: The study shows that the MMFS is effective in improving the nutrition status and cognition in children.

Brunner's gland polyp with upper gastrointestinal bleeding managed by endoscopic polypectomy: a report of two cases.

We report 2 rare cases of Brunner's gland adenoma presenting with upper gastrointestinal bleeding. They were removed by endoscopic polypectomy. In skilled hands, this method is safe and effective.