An uncommon cause of gastric outlet obstruction: A case report

RATIONALE: Metastatic involvement of the gastrointestinal tract is an uncommon scenario encountered in the clinical practice. Our case represents a gastric outlet obstruction (GOO) as a consequence of distant Transitional cell carcinoma (TCC) metastasis without any lymph node involvement in association with inflammatory stranding leading to extrinsic duodenal obstruction. PATIENT CONCERNS: We report an unusual case of a 73-year-old male presented with a five-week history of nausea, vomiting and abdominal pain due to the metastatic extension from TCC that had been considered in remission. DIAGNOSES: Computed tomography (CT) of the abdomen and pelvis revealed new circumferential thickening and inflammatory stranding involving the ascending colon extending to the hepatic flexure. Based on the imaging findings, colonoscopy was pursued which demonstrated a mass at the hepatic flexure and biopsies obtained confirmed invasive transitional cell cancer. INTERVENTION: Patient underwent a Wall Flex (22 mm × 120 mm) metal stent to help alleviate the gastric outlet obstruction. Chemotherapy was planned by oncology. LESSONS: Our case highlights the importance of ruling out distant metastases in the evaluation of new gastrointestinal tract pathology, for instance, Gastric Outlet Obstruction in our patient; with a prior history of TCC without any lymph node involvement under remission.