Gastric Outlet Obstruction Caused by Adhesion Between Remnant Greater Omentum and Lesser Omentum After Laparoscopic Transverse Colectomy

Postoperative adhesive small bowel obstruction is common after abdominal surgery, whereas gastric outlet obstruction (GOO) due to adhesions on the anterior surface of the stomach is extremely rare. We report an 81-year-old man who developed persistent vomiting shortly after laparoscopic transverse colectomy. Computed tomography revealed marked gastric dilatation with a beak sign at the pylorus, and upper gastrointestinal endoscopy showed stenosis from the lower gastric body to the gastric angle without intraluminal lesions. Emergency laparoscopy identified a band-like adhesion between the lesser omentum and the remnant greater omentum crossing the anterior wall of the pyloric region and constricting the gastric outlet. Laparoscopic adhesiolysis with intraoperative endoscopic confirmation of patency relieved the obstruction, and the patient recovered uneventfully. This case highlights that omental-lesser omental bands should be considered as a differential diagnosis of early postoperative GOO after colorectal surgery and that laparoscopic adhesiolysis is a safe, minimally invasive treatment option.