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Results for “PYLORIC STENOSIS”

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PubMedDate not supplied

[Hypertrophic stenosis of the pylorus. Correlations with allergy to milk proteins and atopy].

We performed a study concerning the relationship between hypertrophic pyloric stenosis (HPS), atopy and cow's milk protein allergy (CMPA). Familial history of atopy was documented in 17 (44.7%) of 38 infants having undergone Ramstedt pyloromyotomy for HPS, in 12 (23%) of 52 infants having undergone surgery for inguinal hernia and in 53 (26.9%) of 290 normal controls (significant differences between HPS and other groups). Moreover 9 (23.6%) of 38 infants with HPS presented personal history of eczema at follow-up compared with 3 (5.7%) infants having undergone surgery for inguinal hernia (p less than 0.01). A significant difference between HPS and other groups was also found when looking for familial history of CMPA: 26.3% vs % and 2.5% respectively (p less than 0.001). Eventually we discovered a higher than expected incidence of CMPA both in a retrospectively evaluated group of HPS and in 24 infants undergone Ramstedt pyloromyotomy and followed according to a standardized protocol for a mean period of 4 months (16.6%). The etiology of HPS remains obscure. Our data however suggest some relationship between HPS, atopy and particularly CMPA.

Female↗
PubMed1995

Repair of mucosal perforation during pyloromyotomy: surgeon's choice.

Mucosal perforation during Fredet-Ramstedt pyloromyotomy traditionally has been repaired with muscular and mucosal reapproximation, pyloric rotation, and repeat myotomy. The purpose of this study was to determine whether simple mucosal closure is a safe alternative repair technique for such a perforation. The authors reviewed their experience of pyloromyotomies over a 21-year period and found a 1.67% incidence (15 of 896) of mucosal perforation. Four of these patients had repair with rotation and repeat myotomy, and 11 had repair with primary mucosal approximation. The patients were compared with respect to demographics, duration of operation, postoperative feeding intolerance, time from operation until discharge, and postoperative complications. No differences were noted between the two groups. Interestingly, when the perforation group (n = 15) was compared with the nonperforation group (n = 881), the mean age at time of pyloromyotomy was significantly higher for the group with perforation 48 days v 34 days; P = .0021, Student's t test). The authors conclude that those most likely to suffer mucosal perforation during pyloromyotomy are older patients with pyloric stenosis. Such mucosal perforation can be repaired with equal efficacy and safety using the traditional pyloric rotation approach or primary mucosal closure.

Female↗
PubMed2002

Does dehydration affect thickness of the pyloric muscle? An experimental study.

Congenital hypertrophic pyloric stenosis (CHPS) is a common condition in infancy associated with smooth muscle hypertrophy and resulting in pyloric outlet obstruction. The final diagnosis of CHPS is based on precise ultrasonographic measurements of length and width of the pyloric muscle. Based on our clinical and sonographic experience, we observed that smaller measurements of the pyloric muscle were obtained in dehydrated infants than in children examined after proper fluid restoration. The clinical importance of these observations was evident because false-negative results could be obtained. An experimental animal work followed, proving our clinical observation to be true. A significant difference of about 30% to 50% was found between measurements of the muscle thickness of the gastric and pyloric muscles in a state of water deprivation, as compared with a state of full hydration (p < 0.05). Based on our preliminary results, we suggest that children with suspected CHPS should be well hydrated before the ultrasound (US) examination is performed, to avoid false-negative results and a consequent delay in treatment.

Animals↗
PubMedDate not supplied

Vagotomy without gastric drainage laparoscopic or thoracoscopic approach.

BACKGROUND/AIMS: This article describes the surgical techniques and preliminary results of a prospective trial of videoendoscopic bilateral truncal vagotomy without a drainage procedure in a series of selected patients with chronic non-obstructive intractible duodenal ulcer. METHODOLOGY: Video laparoscopic and videothoracoscopic truncal vagotomy of chronic duodenal ulcer in 32 patients has been successfully performed in the Department of Surgery, Istanbul Medical Faculty Hospital. These patients undergoing bilateral truncal vagotomy (BTV) without a drainage procedure were chosen with selective indication regarding the absence of pyloric obstruction and presence of hyperacidity. Endoscopic pyloric balloon dilatation (PBD) was performed at the same stage with vagotomy only for 20 patients as a prospective trial. The results of acid secretory tests and endoscopic control were studied. RESULTS: All the patients tolerated pure truncal vagotomy well under strict follow-up with semiliquid diet and promotility medication started 24 hours after surgery. The mean decrease in secretory tests for basal acid output (BAO) and peak acid output (PAO) were 70.6% and 79.5%, respectively. Endoscopic controls, 2 months after the operation, showed healing ulcers in patients who were able to be followed-up. One patient who had partial pyloric stenosis and was operated by BTV and PBD, required a drainage procedure in spite of repeated pyloric dilatation. During the mean follow-up period of 26 months (range: 10-46), the only symptom was moderate diarrhea in 4 patients, which became well with medical treatment or spontaneously. CONCLUSIONS: Videoendoscopic truncal vagotomy seems to be an alternative treatment regimen for the management of chronic duodenal ulcer in a group of selected patients, as a simple, surgeon independent and efficient procedure. Instead of routine addition of a drainage procedure after truncal vagotomy, which may improve the morbidity, observation of the patient after truncal vagotomy with dietary caution supplementary to prokinetic medication may be the chosen method in some patients.

Adult↗
PubMedDate not supplied

Multiple gastric diverticulosis: report of a case.

A case of multiple gastric diverticula with pyloric stenosis is reported here. More than 30 diverticula were located throughout the stomach except in the pyloric antrum. The diverticula were divided into two types according to shape: shallow depression and mushroom-like outpouching. This case has the greatest number of gastric diverticula ever reported.

Aged↗
PubMed1986

Conrad Ramstedt--an appreciation.

C. Ramstedt's biographical data are presented and his surgical and scientific capacity is appraised. Special emphasis is on his role in the development of the surgical treatment of hypertrophic pyloric stenosis.

General Surgery↗
PubMed1986

Radiographic findings after incomplete pyloromyotomy.

The gastrointestinal series of 10 patients with persistent vomiting following pyloromyotomies for pyloric stenosis were reviewed. Four patients had incomplete pyloromyotomies and required reoperation. Their studies showed persistent obstruction with elongation and narrowing of the pyloric channel similar to preoperative studies, except that the proximal muscle mass was tapered in 3 of the 4 patients. Six patients with similar histories of postpyloromyotomy vomiting but who did not require repeat surgery had irregular but much wider pyloric channels, good gastric emptying, and gastroesophageal reflux.

Follow-Up Studies↗
PubMed1988

Radiographic and ultrasound appearances of an intra-mural haematoma of the pylorus.

The case of a haemophilic baby boy who developed a pyloric haematoma due to trauma caused by a feeding gastrostomy catheter balloon is presented. Intramural gastric haematomas are rare and the authors are not aware of any previous reports of intramural haematomas affecting the pylorus alone in this age group. The barium meal appearances of the pyloric haematoma were identical to those seen in hypertrophic pyloric stenosis but ultrasound demonstrated a circumferential pyloric haematoma.

Gastrointestinal Hemorrhage↗
PubMed2004

[Characteristics of duodenoplasty in duodenal ulcers of various localization].

Experience and methods of duodenoplasty in duodenal ulcers and pyloric stenosis are presented. Pylorus-saving duodenoplasty in combination with selective proximal vagotomy (SPV) can be performed in the majority of patients with duodenal ulcers. Pyloric sphincter is destroyed by ulcer rarely (7.2%). Removal of ulcerous substrate reduces significantly per cent of postoperative complications, including recurrence of ulcer. Long-term results (from 1 to 20 years) of pylorus-saving duodenoplasty with SPV in 259 patients with duodenal ulcer were analyzed. Low per cent of complications and lethal outcomes have been demonstrated.

Duodenal Ulcer↗
PubMed2000

The posterior approach to pyloric sonography.

Overlying bowel gas or gastric distension may occasionally hinder the sonographic diagnosis of hypertrophic pyloric stenosis. To address this problem, a novel approach for obtaining posterior views of the pylorus is reported. Utilizing this approach may decrease the incidence of nondiagnostic pyloric ultrasonography.

Age Factors↗
PubMed1991

Gastric retention of swallowed coins after pyloromyotomy.

Swallowed coins are a frequent problem in paediatric practice. The majority that reach the stomach will pass unimpeded through the gastrointestinal tract. Prolonged gastric retention of a swallowed penny is reported in three children who had previously undergone pyloromyotomy for infantile hypertrophic pyloric stenosis. The coins were removed after laparotomy in two patients and endoscopically in the third. This abnormal retention may reflect a long-term disturbance of pyloric function after pyloromyotomy.

Child, Preschool↗
PubMed1991

[Ultrasonic diagnosis of gastric motor-emptying disorders].

A method for ultrasonic examination of gastric motor evacuatory function, available for clinical practice, has been developed. Results of parallel estimation of the gastric contents half-life period by the ultrasonic and scintigraphic techniques evidence a high accuracy of the suggested method of echographic estimation of gastric function. Accelerated evacuation of the gastric contents was revealed in patients with duodenal ulcer without ++pyloric stenosis++.

Adult↗
PubMed1983

Dehydration and fluid therapy.

In the clinical setting, dehydration implies loss of both water and electrolytes. This is indeed what occurs in diarrhea, which is the most common cause of dehydration in children. The treatment of diarrhea is detailed first, followed by consideration of several less common conditions leading to dehydration in early infancy, including acute adrenal insufficiency and pyloric stenosis.

Acidosis↗
PubMed1996

Nitric oxide synthesis inhibition: the effect on rabbit pyloric muscle.

The relaxation mechanism of the pyloric smooth muscle is largely dependent on a nonadrenergic noncholinergic (NANC) inhibitory innervation mediated in part by nitric oxide (NO). The aim of the present study was to investigate the effect of NO antagonists on the contractility of the pyloric smooth muscle. In the clinical trial, 10 anesthetized experimental rabbits were infused intraarterially with the NO synthesis inhibitor N-nitro-L-arginine (L-NNA), at a concentration of 10(-4) mol/L; 10 controls received normal saline intraarterially. Pyloric contractility was assessed by balloon manometry. L-NNA infusion produced a dose-dependent increase in the frequency of the pyloric contraction. The maximal increase in frequency occurred during the slow L-NNA infusion rate of 146 ng/min (baseline-adjusted frequencies of experimental v control: 1.267 +/- 0.389 v 0.632 +/- 0.375; P = .001). The increased frequency level was sustained over the subsequent fast infusion rate of 292 ng/min (experimental v control: 1.362 +/- 0.604 v 0.704 +/- 0.579; P = .022). Both the duration and the amplitude of the pyloric contractions were not affected by the L-NNA infusion. These findings suggest that blockage of the L-arginine-NO pathway may have resulted in inhibition of the NANC-induced gastric muscle and relaxation of the pyloric sphincter. The authors speculate that the decreased NO production may be responsible for the sustained contraction of the pyloric smooth muscle with secondary hypertrophy, characteristic of hypertrophic pyloric stenosis.

Analysis of Variance↗
PubMed1990

Pyloric obstruction due to gastric tuberculosis--an endoscopic diagnosis.

A 22 year old male presented with symptoms of gastric outlet obstruction. Endoscopy showed a hypertrophic nodular lesion around the pyloric opening with pyloric stenosis. The endoscopic biopsy and histopathological examination revealed tuberculosis involving the stomach, an extremely rare lesion.

Adult↗
PubMed1989

[Familial malformation recurrence in congenital heart disease].

The intensity and degree of familial association in a series of congenital heart diseases has provided 204 cases of familial malformation recurrence. There was total concordance for 27% of first degree relatives, 18.5% of those of second degree, and 9% of third degree; partial concordance was present in 15, 18 and 41%; system concordance in 27, 44, and 43%; total discordance in 31, 18.5, and 5%. Anencephaly, hydrocephaly, cleft lip-palate, pyloric stenosis, and cryptorchidism were repeatedly present with a highly significant incidence.

Anencephaly↗

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