What to do if the gastric pyloric obstruction

Many people think that if they have pyloric obstruction in their stomach, they must undergo surgery immediately. Only in this way can their condition be cured. In fact, sometimes patients do not need timely surgery. They should wait until their gastrointestinal tract is gradually decompressed before undergoing surgery. This will be better for their body, and patients must resume their diet during this period.

Generally, patients with pyloric obstruction are not suitable for emergency surgery. If after 3 to 5 days of gastrointestinal decompression, the patient can resume eating and the condition gradually improves, it means that the factors of spasm and edema have been eliminated and the patient can continue to be observed. Repeat the barium meal examination if necessary. If decompression is ineffective, it indicates scar stenosis and surgical treatment must be taken. If there is evidence of malignancy, aggressive surgical measures must undoubtedly be taken.

1. Medical treatment

Correcting water loss and electrolyte imbalance is the primary issue in treating pyloric obstruction, because a large amount of gastric acid is lost and there is varying degrees of alkali poisoning. Therefore, after admission to the hospital, normal saline can be given first, and potassium chloride solution needs to be added when the urine volume increases. Patients with severe hypokalemic alkali poisoning may even need to supplement potassium chloride every day. To supplement water, use 5% to 10% glucose solution. Calculated based on the basic daily requirement of 2500 ml, plus the amount sucked out from the gastric tube every day and a portion of the water loss.

Therefore, in addition to the appropriate amount of electrolyte solution according to the results of blood biochemistry tests, the insufficient water is supplemented with glucose solution. Secondly, the dilated stomach is restored by continuous decompression. The disappearance of inflammatory edema allows the tension of the gastric wall muscle layer to be restored. If the obstruction is caused by pyloric spasm or mucosal edema, after the obstruction is eliminated, the diet and corresponding medications should be adjusted according to ulcer disease.

2. Surgical treatment

Short-term medical treatment was ineffective, indicating that scar contracture was the main factor causing pyloric obstruction. Or if it is diagnosed as gastric ulcer after examination, especially if there is suspicion of malignancy, surgical treatment should be performed at a later date after the inflammatory edema disappears due to non-surgical treatment. The simple drainage techniques used in the past, such as pyloroplasty or gastrojejunostomy, cannot solve the problem of ulcer disease. Therefore, gastrectomy or vagotomy is now commonly performed, the latter mainly selective or highly selective vagotomy, while vagotomy is rarely used.