A Rare Case of Type II Adult Hypertrophic Pyloric Stenosis Secondary to Chronic Peptic Ulcer Disease.

Adult hypertrophic pyloric stenosis (AHPS) is a rare subtype of gastric outlet obstruction (GOO) that occurs without a history of recurrent vomiting or other gastrointestinal symptoms in infancy. AHPS type 2 is the most common type of AHPS that arises from underlying GI pathologies such as recurrent peptic ulcer disease (PUD), malignancy, vagal hyperactivity, and extrinsic adhesions. A 43-year-old male with no history of vomiting in infancy presented with a two-day history of intractable nausea, nonbilious and non-bloody forceful vomiting, globus pharyngeus, and worsening dysphagia to both solids and liquids. The patient had experienced similar episodes in the past, all of which were managed conservatively. The computed tomography (CT) of the abdomen/pelvis with IV contrast showed marked distention of the stomach, unable to rule out GOO. Esophagogastroduodenoscopy (EGD) revealed multiple clean-based ulcers with a pinhole-sized opening at the pylorus, making it difficult to pass. A robotic distal gastrectomy with Roux-en-Y reconstruction was subsequently performed without major complications. The pathological examination of the specimen showed focal, moderate, nonspecific chronic inflammation but was negative for Helicobacter pylori, acute inflammation, granuloma, dysplasia, or tumor. The recovery was uneventful, and the patient was discharged without any complications. With history, physical examination, and radiography often failing to provide definitive results, fiberoptic gastroscopy with histopathological examination is a more reliable diagnostic tool. While nonsurgical management, such as proton-pump inhibitors, has shown mild efficacy in treatment, partial gastrectomy remains the definitive surgical approach for symptomatic AHPS. AHPS is a rare cause of gastric outlet obstruction in adults, and diagnosis is based upon radiological and endoscopic findings after excluding other common causes of GOO. We emphasize the importance of including AHPS in the differential diagnosis for patients presenting with globus pharyngeus and dysphagia.