Gastric outlet obstruction caused by an impacted intramural gastric stone mimicking malignant pyloric stenosis: a case report
- 1Department of Surgery, National Hospital Organization Mito Medical Center, Ibaraki-machi, Higashiibaraki-gun, Ibaraki, Japan
Abstract
Introduction:: Gastric cancer is among the leading causes of gastric outlet obstruction (GOO) in adults. We report an extremely rare case of GOO caused by an impacted intramural gastric stone mimicking malignant pyloric stenosis.
Case presentation:: A 91-year-old man presented with nausea and reduced oral intake. Non-contrast computed tomography (CT) revealed marked gastric dilatation and a localized hyperdense lesion within the pyloric wall. Upper gastrointestinal endoscopy revealed an elevated pyloric lesion that made endoscopic passage difficult. Although biopsy revealed no evidence of malignancy, intraoperative findings showed an inflammatory mass involving the pylorus and gallbladder fundus. Because gallbladder invasion by gastric cancer could not be excluded, distal gastrectomy with cholecystectomy was performed. Histopathological examination revealed an impacted intramural stone within the pyloric wall with marked fibrosis and inflammatory changes causing pyloric stenosis. The gallbladder showed adenomyomatosis with multiple gallstones. The intramural stone and gallbladder stones had similar compositions, suggesting a possible pathogenetic relationship.
Case discussion:: Preoperative differentiation from malignant pyloric stenosis was difficult. However, a localized hyperdense lesion within the pyloric wall on CT may provide an important diagnostic clue. Since intramural gastric stones are benign, alternative treatments other than gastrectomy may be considered when a preoperative diagnosis is established.
Conclusion:: Awareness of this rare entity may facilitate preoperative diagnosis and the selection of appropriate treatment when malignancy can be reasonably excluded.
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BibTeX
@article{noguchi2026gastric,
title = {{Gastric outlet obstruction caused by an impacted intramural gastric stone mimicking malignant pyloric stenosis: a case report}},
author = {Aya Noguchi and Ryo Muto and Hiraki Akutsu and Yasuaki Yamamoto and Ryoichiro Wada and Kouji Miyazawa},
journal = {International Journal of Surgery Case Reports},
year = {2026},
month = oct,
doi = {10.1097/rc9.0000000000001220},
url = {https://doi.org/10.1097/rc9.0000000000001220},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Gastric outlet obstruction caused by an impacted intramural gastric stone mimicking malignant pyloric stenosis: a case report
AU - Aya Noguchi
AU - Ryo Muto
AU - Hiraki Akutsu
AU - Yasuaki Yamamoto
AU - Ryoichiro Wada
AU - Kouji Miyazawa
PY - 2026
DA - 2026/10/22
JO - International Journal of Surgery Case Reports
DO - 10.1097/rc9.0000000000001220
UR - https://doi.org/10.1097/rc9.0000000000001220
AB - Introduction:: Gastric cancer is among the leading causes of gastric outlet obstruction (GOO) in adults. We report an extremely rare case of GOO caused by an impacted intramural gastric stone mimicking malignant pyloric stenosis. Case presentation:: A 91-year-old man presented with nausea and reduced oral intake. Non-contrast computed tomography (CT) revealed marked gastric dilatation and a localized hyperdense lesion within the pyloric wall. Upper gastrointestinal endoscopy revealed an elevated pyloric lesion that made endoscopic passage difficult. Although biopsy revealed no evidence of malignancy, intraoperative findings showed an inflammatory mass involving the pylorus and gallbladder fundus. Because gallbladder invasion by gastric cancer could not be excluded, distal gastrectomy with cholecystectomy was performed. Histopathological examination revealed an impacted intramural stone within the pyloric wall with marked fibrosis and inflammatory changes causing pyloric stenosis. The gallbladder showed adenomyomatosis with multiple gallstones. The intramural stone and gallbladder stones had similar compositions, suggesting a possible pathogenetic relationship. Case discussion:: Preoperative differentiation from malignant pyloric stenosis was difficult. However, a localized hyperdense lesion within the pyloric wall on CT may provide an important diagnostic clue. Since intramural gastric stones are benign, alternative treatments other than gastrectomy may be considered when a preoperative diagnosis is established. Conclusion:: Awareness of this rare entity may facilitate preoperative diagnosis and the selection of appropriate treatment when malignancy can be reasonably excluded.
SN - 2210-2612
ER -