Metastatic lung cancer presenting as gastric outlet obstruction: diagnosis and management with laparoscopic gastric bypass: a novel technique

Metastatic tumours of the duodenum are relatively rare. Here we present a case of a 64-year-old Caucasian male who presented with a 3-week history of postprandial vomiting, weight-loss and epigastric discomfort. Imaging and biopsy revealed that the patient had a primary lung tumour in his right upper lung lobe as well as a duodenal metastasis leading to gastric outlet obstruction (GOO). The patient was stabilised and subsequently underwent a laparoscopic gastric bypass to palliate the gastric outlet obstruction. Appropriate management of metastatic GOO involves accurate diagnosis and treatment with either enteral stenting or laparoscopic gastric bypass. It is suggested that the decision whether to stent or surgically bypass the obstruction can be based on the patient's life expectancy and performance status. Regardless of the approach, palliating metastatic GOO can improve the quality of life of carefully chosen symptomatic patients. We describe a technique of laparoscopic palliative gastric bypass which has not been reported previously in the literature.