Gastric Outlet Obstruction Secondary to Severe Thoracolumbar Scoliosis.

ABSTRACT

A 78-year-old woman with a history of idiopathic thoracolumbar scoliosis presented with signs, symptoms, and imaging findings consistent with a gastric outlet obstruction secondary to the rib cage impinging on the pylorus of the stomach. She underwent an operative intervention and intra-operative findings were consistent with severe scoliosis with the right rib cage impinging on the pylorus, causing gastric outlet obstruction. A laparoscopic procedure was performed to pexy the greater curvature of the stomach to the left upper quadrant and a percutaneous endoscopic trans-gastric jejunostomy was inserted at the end. Thoracolumbar idiopathic scoliosis is a relatively benign common condition. However, with the increasing aging population and resultant higher incidence of progression to degenerative scoliosis, more patients are presenting with severe spinal and rib cage deformities that can cause rare intra-abdominal sequelae. We report the first case of a gastric outlet obstruction caused by the rib cage impinging on the pylorus in a patient with severe thoracolumbar scoliosis.