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PubMed1989

[Physiopathology of hypertrophic stenosis of the pylorus: a proposal].

The aim of this report is finding a physiopathologic explanation for the Infantile Hypertrophic Pyloric Stenosis. We studied two groups: The group one were children with infantile hypertrophic pyloric stenosis (n = 43) and the group two were infants who died at one month old due to a non-related cause. We studied the pylorus in both groups, took biopsies and found neurological and muscular lesions with muscular hypertrophy and degeneration of the myenteric plexus of Auerbach. We suggest the diagram of self-maintenance of the lesions.

Humans↗
PubMed1999

[Radiologic diagnosis of congenital anomalies of the digestive tract].

UNLABELLED: The aim of the study is to analyze the frequency of the congenital anomalies of the digestive tract in the period of 1993-1998. The patients and methods: Our group included 67 patients (47 males and 20 females; age range 1-12 months) suspected of digestive tract anomalies. First, all of them have been examined by pediatric surgeon. At the first place, we used the most conventional radiological procedures for digestive tract examination. They were followed by US in cases with suspicion on hypertrophic pyloric stenosis and biliary atresia (bile-duct atresia). CT and MR were performed in patients with anorectal anomalies. In cases with suspected associated anomalies of other organs, intravenous urography and chest radiography were used. RESULTS: Congenital anomalies and abnormalities of the digestive tract were diagnosed in 25 patients. The most frequent anomaly was hypertrophic pyloric stenosis (n = 14), followed by invagination (n = 12) and megacolon congenitum (n = 9), all predominant in male sex. All radiological findings we confirmed at surgery (100%). CONCLUSION: Conventional radiology is still extremely useful in the diagnosis of the digestive tract anomalies; also US revealed to be essential in the diagnosis of the hypertrophic pyloric stenosis and the intestinal invagination. Recognition of the associated anomalies should lead to application of the other examination techniques like CT and MR. MR might be useful in the anorectal malformations and hepatobiliary tract anomalies, but we have no experience in that field, till now.

Digestive System Abnormalities↗
PubMed1991

Value of ultrasound in differentiating causes of persistent vomiting in infants.

A prospective study of abdominal ultrasound was undertaken in 100 consecutive infants who presented with a history of persistent vomiting aged 5 to 90 days. Each infant had a 'test feed' followed by an ultrasonographic scan of the pylorus at the cotside. On test feeding a palpable tumour was evident in 38 infants. On real time ultrasound using the criteria for diagnosing pyloric stenosis, these 38 infants as well as six others were documented as having pyloric stenosis. In the other 56 patients the vomiting settled in six and a barium examination was performed on the remaining 50. This confirmed gastro-oesophageal reflux in 46, two of whom had an associated hiatus hernia, one with a duodenal malrotation, and three were reported as normal. Ultrasound of the abdomen is an accurate, reliable, and rapid screening method to differentiate the causes of severe vomiting in infancy.

Diagnosis, Differential↗
PubMed1999

Antimicrobial treatment for peptic stenosis: a prospective study.

OBJECTIVE: Peptic stenosis, a complication of peptic ulcer disease, is treated by endoscopic balloon dilation or surgery. However, recent reports showed that Helicobacter pylori eradication may resolve peptic stenosis. Thus, we carried out a prospective study on a cohort of patients with peptic stenosis and H. pylori infection to evaluate the efficacy of anti- H. pylori therapy in the treatment of peptic stenosis. DESIGN/METHODS: From May 1995 to May 1998 we studied 22 consecutive patients with benign peptic stenosis (16 with duodenal stenosis and six with pyloric stenosis) and H. pylori infection. Searches for H. pylori were made at first diagnosis of peptic stenosis and at every endoscopic control. All patients were treated with an anti- H. pylori treatment (13 with omeprazole/clarithromycin/ metronidazole and nine with omeprazole/amoxycillin/ clarithromycin), followed by 8 weeks' therapy with a proton-pump inhibitor. Endoscopic controls were performed after the end of H. pylori-eradication therapy, at 2 and 6 months, and then every 6 months. RESULTS: H. pylori eradication was achieved in all patients. Peptic stenosis disappeared completely in 20/22 cases (17/20 after 2 months and 3/20 after 6 months), and in all these patients the symptoms disappeared within 2 months. At the median follow-up of 12.4 months (range 2-24), the patients remained asymptomatic, without recurrence of the stenosis, and needed no medication. In one patient the stenosis disappeared partially and symptoms improved, and it was successfully treated with cisapride. In one patient the stenosis did not disappear despite H. pylori eradication and continuous proton-pump inhibitor treatment. The patient was treated with a liquid diet due to old age, but he died 4 months after H. pylori eradication due to stroke. CONCLUSIONS: H. pylori eradication is a safe and effective therapy for peptic stenosis. Endoscopic balloon dilation or surgery should be used only after failure of this conservative treatment.

Adult↗
PubMed1984

The pylorus in infancy: overall sonographic assessment.

A prospective ultrasonic evaluation of the pylorus was performed in two groups of infants, a control group and a group of infants clinically suspected of having hypertrophic pyloric stenosis (HPS). The mean pyloric length in the hypertrophied condition was 84% longer than the mean length in the normal. The mean and standard deviation (sd) for the transverse diameter and pyloric wall thickness in the normals were 7.45 +/- 2.2 mm and 2.3 +/- 0.7 mm respectively, while the corresponding measurements for the mean and sd in HPS were 13.4 +/- 1.6 mm and 4.5 +/- 0.9 mm. In most of the HPS cases the known morphological changes of the antro-pyloric region such as: impingement on the fluid filled antrum, pre-pyloric antral thickening, extension of fluid into the proximal portion of the pyloric canal and the angle formed between antral peristaltic wave and pyloric mass, were observed. Detection of these changes furnished further criteria for highly accurate diagnosis of HPS even of borderline cases.

Female↗
PubMed1993

Vasoactive intestinal polypeptide causes relaxation of the pyloric sphincter in the rabbit.

Vasoactive intestinal peptide (VIP), which causes relaxation of gastrointestinal smooth muscle, has been found in high concentrations in the pylorus in many animal species, suggesting a prominent role for VIP in the control of pyloric sphincter function. We infused VIP into the gastric artery of 6 rabbits at rates from 12 to 1,200 ng/min and measured the intensity, duration, and frequency of spontaneous pyloric contractions with an intraluminal balloon and electromyography. VIP produced a dose-dependent reduction in the intensity (55% +/- 15% of baseline, P < .001) and the duration (29% +/- 25%, P < .001) of pyloric contraction. Maximal inhibition was observed at an infusion rate of 240 ng/min. The frequency of contractions did not decrease significantly in response to VIP infusion. Neostigmine infusion increased the intensity of pyloric contraction in a dose-dependent manner in doses of 0.10, 0.15, and 0.25 mg (140% +/- 78%, 273% +/- 76%, and 357% +/- 26% of baseline, respectively; P < .001). VIP infusion at 12 ng/min and 480 ng/min completely inhibited the increased intensity of contraction at neostigmine doses of 0.10 and 0.15 mg, respectively. Our results show that VIP decreases the intensity and the duration of pyloric contraction in a dose-dependent manner. As pyloric spasm may contribute to the pathogenesis of hypertrophic pyloric stenosis, we can postulate a role for reduced VIP-induced relaxation in the pathophysiology of hypertrophic pyloric stenosis.

Animals↗
PubMed1997

[Long-term results of endoscopic balloon dilatation of ulcer-induced pyloric stenoses--follow-up of 25 patients].

Long-term results of the "through the scope balloon dilatation" for treatment of benign pyloric stenosis are lacking. Therefore we retrospectively analyzed 25 patients treated by balloon dilatation because of benign pyloric stenosis between 1986 and 1995. The mean age was 63 years (18-88 years), there were twelve men and 13 women. The mean follow-up period was 38 months (twelve to 120 months). 92% (23 patients) underwent successful dilatation. 20% (five patients) presented with recurrent obstruction. They were treated again and none of them has had symptoms up to now. There were no complications due to dilatation. Through the scope balloon dilatation is a successful and cost effective therapy for benign gastric outlet obstruction also in long-term follow-up.

Adolescent↗
PubMed1995

Laparoscopic treatment of duodenal ulcer by bilateral truncal vagotomy and endoscopic balloon dilatation.

The low morbidity and early recovery associated with laparoscopic procedures have shown a new direction for many types of surgery. We performed a laparoscopic bilateral truncal vagotomy (BTV) with pyloric dilatation (PD) in 20 patients (11 men, 9 women, ranging in age from 32 to 56 years, with a mean age of 42 years). All patients had chronic duodenal ulcer diagnosed endoscopically, with a mean duration of symptoms of 2.6 years (range 2-8 years). The mean length of surgery was 55 min (range 45-90 min). The mean follow-up period was 16 months (range 3-25 months). In 1 patient, esophageal perforation occurred during the dissection of the left vagus nerve and was sutured laparoscopically. Acid secretion tests under basal conditions and pentagastrin stimulation preoperatively and 1 month postoperatively showed a decrease in basal acid output (BAO) of 76% and maximal acid output (MAO) of 84.2%. Endoscopy at the second and sixth postoperative month showed healing of the ulcer in 19 of 20 patients (95%). One patient had partial pyloric stenosis due to chronic duodenal ulcer before BTV and PD and developed complete pyloric stenosis after the surgery. Despite repeated pyloric balloon dilatation, he required an open drainage procedure (gastroduodenostomy, Jaboulay). Three patients (15%) had postoperative diarrhea and responded very well to medical treatment. The preliminary results showed that laparoscopic BTV with PD is a simple and effective procedure for the treatment of chronic duodenal ulcer.

Adult↗
PubMed1983

Endoscopic incision of postoperative stenoses in the upper gastrointestinal tract.

Membrane-like upper gastrointestinal stenoses, such as may occur after surgery, can be treated by making radial diathermy incisions, producing an increased caliber and a smooth, supple wall at the site of the stenosis. This method has been used in six patients with stenoses after various operations on the upper gastrointestinal tract, including two esophageal and two gastric anastomoses, one gastroplasty, and one pyloric stenosis. The result was favorable in all cases except the pyloric stenosis.

Adult↗
PubMed1984

[Diagnosis of hypertrophic stenosis of the pylorus by ultrasonography].

Ten infants with a clinical history of hypertrophic pyloric stenosis were examined sonographically. Upper gastrointestinal series were also performed on these patients. The authors comment on the findings, and the value of ultrasound examination in the diagnosis of hypertrophic pyloric stenosis.

Child, Preschool↗
PubMed1990

Pseudo-pyloric tumours.

Two infants presenting with vomiting were thought to have palpable pyloric tumours. At operation hypertrophic pyloric stenosis was not present, but other conditions causing duodenal obstruction were, and these required surgical treatment. The cases illustrate that other abnormalities may masquerade as pyloric stenosis.

Diagnosis, Differential↗
PubMed1975

The use of metoclopramide in acute pyloric obstruction. A clinical trial.

Twelve patients with complete, or nearly complete, pyloric obstruction due to duodenal ulcer, were treated conservatively with metoclopramide. The purpose of this therapeutic trial was to avoid emergency operations in these patients and to enable a better radiological evaluation and clinical preparation before surgery. The treatment, in addition to the usual gastric decompression and fluid and electrolyte replacement therapy, was effective in 10 patients (83.4 percent). In eight of these patients the results of the trial was regarded as "very good". Six of them were operated upon electively later and two were not operated upon at all. In two patients the results were regarded as "good". These patients underwent early elective surgery. In the remaining two patients (16.6 percent) the trial failed and semiurgent operation could not be avoided. As no side-effects are evident following the administration of metoclopramide and no harm is done by delaying surgery for three days, it is suggested that this therapeutic trial should be undertaken in every case of pyloric stenosis or obstruction. This may markedly reduce the need for emergency operation and prevent many postoperative complications which not uncommonly follow emergency surgery for pyloric stenosis.

Adolescent↗
PubMed1994

Barium extravasation discovered some years after pyloromyotomy.

Two children who had surgery for pyloric stenosis are presented. Each had an unusual density discovered on an abdominal plain radiograph taken at least a year after surgery for pyloric stenosis. Subsequent investigation showed that this density represented barium from the preoperative contrast studies that had apparently leaked into the soft tissues at the time of surgery but was not recognized at that time. This unusual complication has not been previously reported but could potentially be fairly common. Unnecessary diagnostic testing could be avoided by recognition that this complication does occur.

Barium Sulfate↗
PubMed1997

Acquired gastric outlet obstruction during infancy and childhood: a report of five unusual cases.

Infantile hypertrophic pyloric stenosis is a common, specific, and well-understood entity in the pediatric age group. Prepyloric webs and diaphragms are the other rare causes of gastric outlet obstruction followed by still rarer causes, eg, pyloric stenosis secondary to acid peptic disease. The present report describes a newer, nonspecific, clinical condition of pyloric obstruction in five patients of varying age who responded very well to Henieke-Mikulicz' pyloroplasty. The authors have suggested some modifications in the classification of gastric outlet obstruction in children to include these patients.

Child↗
PubMed1980

Diagnostic advantages of manual compression fluoroscopy in the radiologic work-up of vomiting neonates.

This paper describes a simple and effective fluoroscopic technique that remarkably improves diagnostic accuracy when evaluating vomiting newborns. The technique also minimizes the time of the examination and the radiation dose to the patient and radiology personnel. Several examples are presented illustrating the superiority of gloved hand or nonopaque compression technique to conventional contrast radiography, emphasizing babies with pyloric stenosis and midgut malrotation. The technical limitations and diagnostic pitfalls of conventional contrast modalities are compared to the highly diagnostic images obtained with manual compression fluoroscopy. All of the classic radiographic signs of pyloric stenosis can be mimicked by antral spasm or pylorospasm. Gloved hand compression overcomes antral spasm and clearly shows the true length and diameter of the pyloric canal in these two conditions. Malposition of the duodenojejunal junction is the only consistently diagnostic sign of midgut malrotation. Nonfixation of the duodenojejunal junction can be competently assessed by compression fluoroscopy, confirming malrotation and midgut volvulus simultaneously and bringing the patient to operation much sooner than with less precise conventional techniques. Gloved hand compression technique also evaluates stenotic areas in the upper gastrointestinal tract, distinguishing spasm from organic marrowing and clearly identifying those which need surgical intervention. Facilitating intubation of the duodenum is a final contribution of compression fluoroscopy.

False Negative Reactions↗
PubMed1996

Antibiotic prophylaxis for infantile pyloromyotomy.

A retrospective study of 50 patients with infantile hypertrophic pyloric stenosis (IHPS) showed wound infection in six patients. In an attempt to assess the value of antibiotic prophylaxis in infantile pyloromyotomy 150 patients with infantile hypertrophic pyloric stenosis were entered in a prospective randomized controlled study. The infants were allocated to receive a dose of Cefuroxime (30 mg/kg) at induction of anaesthesia or no antibiotic. Eight infants developed wound infection, five in the control group and three in the antibiotic prophylaxis group. Although the difference between the two groups was not statistically significant there was an overall reduction of wound infection (6.5%) compared with pre-trial figures (12%). In order to study the bacterial flora in the umbilicus in these infants, culture swabs were taken from the umbilicus on admission, immediately prior to surgery and from the wound prior to skin closure. It was shown that the umbilicus was not the source of infection.

Antibiotic Prophylaxis↗