Gastric outlet obstruction

Case contributed by Dachani Kansan Naider
Diagnosis almost certain


Patient with unintentional weight loss. History of cholangiocarcinoma with a common bile duct stent in situ.

Patient Data

Age: 90 years
Gender: Female

Grossly distended stomach with no CT evidence of perforation. The proximal part of the duodenum is narrowed in between the CBD stent and gall bladder.

There is diffused ill-defined circumferential soft tissue prominence surrounding the CBD stent. This is compatible with the known cholangiocarcinoma.

The pancreatic head hypodense mass causes obstruction of the main pancreatic duct. The distal pancreatic duct is dilated. The remaining pancreatic body is atrophic.

Mildly dilated intrahepatic duct with pneumobilia.

Cavernous transformation of the portal vein.

Case Discussion

A case of gastric outlet obstruction due to a pancreatic head mass not separable from a circumferential common bile duct mass in a patient with a history of cholangiocarcinoma and weight loss. The mass is thought to represent direct tumoral invasion. Alternatively, a separate pancreatic primary can demonstrate a similar appearance and has to be considered as a differential diagnosis.

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