A patient with Crohn disease presents with severe upper abdominal discomfort, vomiting that is relieved by vomiting, distension, and a succussion splash. The most likely diagnosis is?

• A. Small bowel obstruction
• B. Colonic obstruction
• C. Intestinal obstruction
• D. Gastric outlet obstruction

Answer: (D)

This scenario points to a gastric outlet obstruction. The key clue is the succussion splash—a splash heard when the abdomen is shaken due to a mixture of gas and liquid in a distended stomach. That finding indicates the stomach itself is dilated and not emptying, which is exactly what happens with an obstruction at the gastric outlet (pylorus or proximal duodenum). The vomiting that is relieved by vomiting and the upper abdominal distension further fit a proximal obstruction rather than a downstream one. Crohn disease can cause such an obstruction if it involves the stomach or pyloric region with inflammation and scarring. In contrast, small bowel or colonic obstructions produce different patterns of pain, distension, and bowel sounds, and they typically lack the classic succussion splash associated with a gastric outlet problem.