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Gastric outflow obstruction caused by gall stones and leading to death by complex metabolic derangement

Journal Article


Abstract


  • A 67 year old woman was admired with a three week history of vomiting; having become increasingly confused for three days; Investigations revealed deranged serum biochemistry consistent with a combination of a diabetic non- ketotic hyperosmolar state and a metabolic alkalosis consistent with gastric outflow obstruction. She was treated with intravenous saline, intravenous insulin, and subcutaneous heparin, but did not improve clinically and had an asystolic cardiac arrest the following day; she was transferred to the intensive care unit and despite treatment with inotropes she died 40 hours after admission. Necropsy revealed that the stomach was massively dilated with gas and stomach contents, and contained many small black faceted gall stones. In addition a large nonfaceted brown-yellow gall stone was wedged in the pyloric antrum causing total obstruction. The patient had died from a complex metabolic derangement including non-ketotic hyperosmotic diabetic coma and metabolic alkalosis precipitated by the acute gastric outflow obstruction complicated by previously undiagnosed type II diabetes mellitus.

Publication Date


  • 1997

Publisher


Citation


  • Wight, C. O., Seed, M., Yeo, W. W., & McCulloch, T. A. (1997). Gastric outflow obstruction caused by gall stones and leading to death by complex metabolic derangement. Journal of Clinical Pathology, 50(11), 963-965. doi:10.1136/jcp.50.11.963

Scopus Eid


  • 2-s2.0-0030831844

Start Page


  • 963

End Page


  • 965

Volume


  • 50

Issue


  • 11

Abstract


  • A 67 year old woman was admired with a three week history of vomiting; having become increasingly confused for three days; Investigations revealed deranged serum biochemistry consistent with a combination of a diabetic non- ketotic hyperosmolar state and a metabolic alkalosis consistent with gastric outflow obstruction. She was treated with intravenous saline, intravenous insulin, and subcutaneous heparin, but did not improve clinically and had an asystolic cardiac arrest the following day; she was transferred to the intensive care unit and despite treatment with inotropes she died 40 hours after admission. Necropsy revealed that the stomach was massively dilated with gas and stomach contents, and contained many small black faceted gall stones. In addition a large nonfaceted brown-yellow gall stone was wedged in the pyloric antrum causing total obstruction. The patient had died from a complex metabolic derangement including non-ketotic hyperosmotic diabetic coma and metabolic alkalosis precipitated by the acute gastric outflow obstruction complicated by previously undiagnosed type II diabetes mellitus.

Publication Date


  • 1997

Publisher


Citation


  • Wight, C. O., Seed, M., Yeo, W. W., & McCulloch, T. A. (1997). Gastric outflow obstruction caused by gall stones and leading to death by complex metabolic derangement. Journal of Clinical Pathology, 50(11), 963-965. doi:10.1136/jcp.50.11.963

Scopus Eid


  • 2-s2.0-0030831844

Start Page


  • 963

End Page


  • 965

Volume


  • 50

Issue


  • 11