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PubMed1975

Gastric emptying in newborns and young infants. Measurement of the rate of emptying using indium-113m-microcolloid.

The rate of gastric emptying was measured in newborns and young infants by a new radio-isotopic method. 28 control babies and 6 infants with projectile vomiting were given a 50 ml standard milk feeding containing 15 muCi of Indium-113m-microcolloid. The radioactivity in the stomach was counted at regular intervals with a gamma-camera. The gastric emptying followed an exponential pattern with a "half-life" of 87 plus or minus 29 minutes in 24 out of 28 control babies. In 6 patients with projectile vomiting gastric emptying was impaired severely. Three of them with hypertrophic pyloric stenosis showed complete stasis of gastric contents. Gastric emptying returned to normal 8-16 days after pyloromyotomy. It is suggested that the radioisotopic technique is helpful in evaluating the severity of pyloric stenosis and that it is of value in studies of the action of pharmacological substances on gastric emptying.

Half-Life↗
PubMed1998

Laparoscopic pyloromyotomy.

Extramucosal pyloromyotomy is a method with predictable morbidity and outcome for the cure of infantile hypertrophic pyloric stenosis. The method created by Ramstedt is successfully performed using a laparoscopic approach. Preliminary reports, including 266 cases treated by laparoscopic pyloromyotomy (LP), suggest that morbidity is comparable to that of open approaches. Advantages of LP include superior cosmetic result and no reported wound infections to date. For the experienced laparoscopic surgeon, LP is an precise and efficient technique, and the preferred method for the management of infantile hypertrophic pyloric stenosis.

Humans↗
PubMedDate not supplied

[Congenital pyloric hyperthrophy. Factors associated with its frequency].

With the idea of clearing out several variables individually found associated with a greater incidence of congenital pyloric stenosis in the same group of children, 298 clinical histories in infants complaining of this deviation were reviewed. Information was obtained as to sex, birth number, blood group and the month these children with stenosis were born. The distribution of frequencies in each one of these variables was compared to that in 309 children surgically operated from peritonitis. The results showed a greater incidence of congenital pyloric stenosis in males than in females; also, the disease appeared more frequently in first-borns. Patients with type A blood group were less prone to present the anomaly. The birth month showed no statistical difference. The findings stress the importance shown by the genetic component of this disease.

Blood Group Antigens↗
PubMed2004

A new technical variant for extramucosal pyloromyotomy: the Tan-Bianchi operation moves to the right.

BACKGROUND: Since its first publication in 1986, the Tan-Bianchi procedure for treatment of infantile hypertrophic pyloric stenosis has displayed a growing consensus among pediatric surgeons. However, in up to 30% of cases, the supraumbilical skin fold incision does not allow a comfortable access. Delivery through this route, a large pyloric tumor into the wound to perform a pyloromyotomy, can be fairly difficult and time consuming and may damage the gastric or duodenal serosa by tearing. Other technical variants have been proposed to overcome these limitations, but some are more complicated, some are demanding, and some others can worsen the final cosmetic result. METHODS: The authors present a personal modification to the Tan-Bianchi procedure that they have successfully applied in the last 25 cases of infantile hypertrophic pyloric stenosis. A right semicircular umbilical skin fold incision is performed. The anterior rectus abdominis muscle (RAM) sheath is incised vertically all around the umbilicus, the muscle is laterally displaced, and its posterior sheath and the peritoneal cavity entered in the same line. Because all incisions lay in the same axis, the abdominal cavity is largely opened by 2 retractors without the need for excessive increased traction as it often happens with the supraumbilical approach. RESULTS: This technical variant was particularly useful to deliver a very large hypertrophic pyloric muscle into the wound. There were no complications and excellent cosmetic results were obtained in all patients. CONCLUSIONS: These observations suggest that a right semicircular umbilical skin fold incision is an attractive alternative for pyloromyotomy mostly when facing with a large pyloric tumor.

Digestive System Surgical Procedures↗
PubMed2006

[A case of advanced gastric cancer treated by TS-1 for 3 years and 7 months].

A 72-year-old man was diagnosed as gastric cancer with pyloric stenosis by an upper gastorintestinal endoscopy for anemia in July 2001. Computed tomography (CT) of the abdomen showed multiple liver metastases. Serum CEA was 6.2 ng/ml. At laparotomy to improve anemia and pyloric stenosis in September 2001, lymphnode metastases invaded the stomach and the pancreatic body. Gastro-jejunostomy was performed without gastrectomy. Oral administration of 100 mg of TS-1 for 28 consecutive days followed by a 14-day rest was given postoperatively. The response assessment of chemotherapy after 1 year was no change (NC) of the primary lesion on endoscopic examination, and liver metastases showed a partial response (PR) on CT. Serum CEA was raised to 86.1 ng/ml in April 2004. The treatment was changed to weekly paclitaxel. The patient died in July 2005. This case with unresectable gastric cancer had been treated by oral administration of TS-1 as an outpatient for 3 years and 7 months.

Administration, Oral↗
PubMed2005

Supraumbilical pyloromyotomy: a unique indication for antimicrobial prophylaxis.

BACKGROUND: The umbilical fold incision for infantile hypertrophic pyloric stenosis provides a convenient exposure and cosmetically appealing scar. This study investigates the possible difference in infection rates between traditional and supraumbilical approaches for pyloromyotomy. METHODS: All patients who underwent pyloromyotomy for infantile hypertrophic pyloric stenosis at a tertiary pediatric hospital were reviewed. Baseline wound infection rate was determined through review of patients with right upper quadrant incisions (group 1). A nonrandomized comparison was performed between patients with a supraumbilical approach (group 2) and those undergoing supraumbilical incisions after prophylactic antibiotic administration (group 3). RESULTS: Complete records were reviewed on 384 patients over a 6-year period. Demographics and preoperative factors were similar among groups. The rate of infection in group 1 (n = 258) was 2.3%. With introduction of the supraumbilical approach, there was a statistically significant increase in wound infection rate to 7.0% (chi 2 ; group 1 vs group 2, P < .05). The use of prophylactic antibiotics with a supraumbilical approach reduced this rate of infection back to 2.3% (chi 2 ; group 1 vs group 3, P < 1.0 and group 2 [n = 85] vs group 3 [n = 42], P < .3). CONCLUSIONS: The risk of wound infection by classic pyloromyotomy of 2.3% is significantly increased with an open supraumbilical approach. The use of prophylactic antibiotics reduces this risk of wound infection.

Anti-Infective Agents↗
PubMed2001

A population-based case-control teratologic study of nalidixic acid.

OBJECTIVE: Quinolones, mainly nalidixic acid, are frequently used in Hungary to treat bacterial infections in pregnant women, but so far no controlled epidemiological studies of congenital abnormalities among infants born to women treated with nalidixic acid during pregnancy have been reported. METHODS: The analysis of oral nalidixic acid use during pregnancy in the mothers of cases with congenital abnormalities and in their matched population controls without congenital abnormality was carried out in the population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. The study included 22865 women who had newborns or fetuses with congenital abnormalities, and 38151 pregnant women who had newborn infants without any defects (controls). RESULTS: In the case group, 242 (1.1%) and in the control group, 377 (1.0%) pregnant women were treated with nalidixic acid (crude OR: 1.1 with 95% CI: 0.9-1.3). Seventeen different congenital abnormality groups were evaluated and a higher prevalence of pyloric stenosis was found in seven case infants born to mothers who received nalidixic acid treatment during the last months of pregnancy (adjusted OR: 11.0 with 95% CI: 1.3-91.4). CONCLUSIONS: Treatment with nalidixic acid during pregnancy may increase the risk of pyloric stenosis, though the chance effects cannot be excluded.

Abnormalities, Drug-Induced↗
PubMed1998

Congenital malformations and perinatal morbidity associated with intestinal neuronal dysplasia.

A close relation between different forms of dysganglionosis such as intestinal neuronal dysplasia (IND) type B and aganglionosis has been established. No systematic analysis of other malformations and diseases accompanying IND has been made as yet. Congenital malformations and perinatal morbidity were analyzed in 109 patients with IND seen at the Department of Pediatric Surgery in Mainz from 1977 to 1996. IND was associated with Hirschsprung's disease in 47 cases; 22 children with IND had other abdominal malformations, including anal atresia, rectal stenosis, sigmoidal stenosis, ileal atresia, pyloric stenosis, and esophageal atresia. A cystic bowel duplication, a choledochal cyst, and a persisting urachus were also found. Extra-abdominal malformations such as Down's syndrome, congenital diaphragmatic hernia, aortic stenosis, and malformations of vertebral bodies were seen. Twin siblings of children with IND were either healthy (n=3) or died in utero (n=1). Seventeen children with IND developed severe intra-abdominal complications during the perinatal period such as necrotizing enterocolitis (NEC), meconium ileus, or bowel perforations. NEC was frequently associated with preterm birth. Bowel perforations were seen in mature and preterm newborns with IND. Taken together, IND is found in a variety of obstructive bowel diseases. This may support the hypothesis that IND is a secondary phenomenon or that congenital atresias and stenoses of the digestive tract have a pathogenesis similar to that of intestinal innervation disturbances. IND may also be a part of complex malformation patterns since it occurs with a number of extraintestinal and non-obstructive intestinal malformations.

Abnormalities, Multiple↗
PubMedDate not supplied

A new incision for pyloromyotomy.

Over the past two years forty infants with hypertrophic pyloric stenosis have been operated on using a supraumbilical transverse midline skin incision with retraction of the two rectus muscles apart. This incision has given us good exposure, has improved the delivery of the pylorus, produced a strong closure, and given a good cosmetic result. We propose this incision as an alternative to be used in the operative approach to the pylorus in the treatment of hypertrophic pyloric stenosis.

Abdominal Muscles↗
PubMed2002

A comparison of laparoscopic and open pyloromyotomy at a teaching hospital.

BACKGROUND/PURPOSE: An increasing number of pediatric surgeons are using the laparoscopic approach to treat pyloric stenosis. The advantage of laparoscopic pyloromyotomy is uncertain and has not been evaluated in the setting of a pediatric surgery fellowship program. METHODS: The authors retrospectively reviewed the medical records of all patients who underwent pyloromyotomy for congenital hypertrophic pyloric stenosis at their institution from January 1, 1997 through December 31, 2000 (n = 117). Information obtained included age, sex, weight, admission laboratory values, attending surgeon, resident surgeon and their level of training, operating time, intraoperative and postoperative complications, time to full feedings, incidence of postoperative emesis, duration of postoperative emesis, length of stay, and total hospital charges. These variables then were compared between the open (OPEN) and laparoscopic (LAP) groups. RESULTS: From January 1, 1997 through December 31, 2000, 65 LAP and 52 OPEN pyloromyotomies were performed. Characteristics of patients in the OPEN and LAP groups were similar. The mean operating time was 33 +/- 2 minutes for OPEN versus 38 +/- 2 minutes for LAP (P =.07). The incidence of postoperative emesis (LAP, 68%, OPEN, 65%), duration of postoperative emesis (LAP, 7.3 +/- 1.2 hours; OPEN, 8.1 +/- 1.8 hours), and time to full feedings (LAP, 19.5 +/- 1.6 hours; OPEN, 19.5 +/- 1.3 hours) did not differ significantly between groups (P >.05). Mean postoperative length of stay in both groups was similar (LAP, 31 +/- 5; OPEN, 28 +/- 2 hours; P =.64). Mucosal perforation occurred in 5 patients (8%) in the Lap and 2 patients (4%) in the OPEN group (P =.39). Postoperative complications occurred in 12 LAP (18%) and 6 OPEN patients (12%, P =.31). Five LAP cases were converted to OPEN. In the LAP group there was one unrecognized mucosal perforation and one incomplete pyloromyotomy both of which required reoperation. As the laparoscopic approach was adopted, general surgery resident participation as operating surgeon in these cases decreased from 81% in 1997 to 19% in 2000. Hospital charges were higher in the LAP group, but not significantly (LAP, $6,676 +/- 1,005; OPEN, $5,292 +/- 306; P = 27). CONCLUSIONS: Laparoscopic pyloromyotomy has progressively become the dominant surgical approach to pyloromyotomy at our institution. The LAP and OPEN approaches have similar outcomes. However, the Lap approach may be associated with increased complication rates, a reduction in general surgery resident operative experience, and higher hospital charges.

Digestive System Surgical Procedures↗
PubMedDate not supplied

Absorption of medium chain triglycerides in the stomach of the human infant.

Following previous observations that medium chain triglycerides (MCT) are absorbed from the stomach of suckling rats, this study was devoted to studying absorption of MCTs in human infants. Four groups of patients were studied: (a) infants suffering from pyloric stenosis, (b) premature infants, (c) children suffering from cystic fibrosis, (d) infants with miscellaneous conditions. Infant formulae with known amounts of MCT were introduced by gastric tube and samples were removed at 0, 20, 40, and 60 min. In patients with pyloric stenosis there was an 18.1% decrease in MCT during the first 20 min. No significant changes in MCT took place during the subsequent 40 min. A similar response was observed in the group of premature infants. Older infants with miscellaneous diagnoses and children with cystic fibrosis showed an even rate of disappearance of MCT during the 60-min test period, and approximately 30% of the original MCTs present disappeared during this period. We conclude that MCTs are absorbed in the stomach of infants and children. Absorption appears to improve with age. Because MCT are an important constituent of formulae for premature infants and children with defects of small intestinal digestion and absorption of fat, these observations have practical implications.

Cystic Fibrosis↗
PubMed1982

Isolated granulomatous disease of the stomach.

A case of isolated granulomatous gastritis observed in a 66-year-old female patient is reported. The gastric granulomatosis gave rise to pyloric stenosis, and at the first explorative laparotomy the change was misdiagnosed for an inoperable tumour. Gastroscopy then revealed the presence of a peptic ulcer, which healed completely on drug therapy. At the second surgical intervention undertaken on account of a relapse after 2 years, Billroth II type resection of the stomach led to complete recovery; the patient has been free from complaints ever since. It is suggested that in addition to peptic ulcer and tumour, isolated gastric granulomatosis should be taken into consideration as the underlying mechanism of pyloric stenosis.

Aged↗
PubMedDate not supplied

An audit of peptic ulcer surgery in Ibadan, Nigeria.

BACKGROUND: Several operations are useful for peptic ulcer surgery, these include Vagotomy and pyloroplasty, Vagotomy and antrectomy, Vagotomy and gastrojejunostomy, and Highly Selective Vagotomy to name a few. Utilising any of these procedures may be due to the operator's preference or more importantly the suitability of the operation to the individual patient. This study was carried out to see the surgical presentation of chronic peptic ulcer disease patients and the form of ulcer-surgery utilised in the University College Hospital Ibadan, Nigeria. STUDY DESIGN: A retrospective study of all the patients who were operated on for complications of peptic ulcer disease between January 1990 and December 2003 at the above-mentioned institution by studying the case-files, ward admission records and operation room registers of such patients. RESULT: There were 122 patients, 90 male and 32 female with a Male:Female ratio of 3:1. Pyloric stenosis accounted for 56.6% of patients followed by perforation (29.5%), bleeding (9.8%) and gastric ulcer (4.1%). Yearly presentations seem to be reducing. Truncal vagotomy and drainage was performed in 78.64% of the patients, simple closure for perforation in 29.5%, partial gastrectomy for 4.1% while the remaining 2.4% had underunning of a bleeding vessel. CONCLUSION: Pyloric stenosis (also called gastric outlet obstruction) is the most common surgical presentation of peptic ulcer disease in the University College Hospital Ibadan and Truncal Vagotomy and drainage is the most common surgical procedure performed for peptic ulcer.

Adolescent↗
PubMed2004

Retrospective comparison of open versus laparoscopic pyloromyotomy.

BACKGROUND: Laparoscopic pyloromyotomy is gaining popularity in the management of pyloric stenosis. However, there is no unequivocal evidence in favour of the laparoscopic over the open approach. This paper reports an experience with laparoscopic pyloromyotomy and an attempt to identify any benefit over the open procedure. METHODS: This was a retrospective review of all 87 pyloromyotomies performed at this institution for pyloric stenosis over the 39 months since the first laparoscopic pyloromyotomy was performed. RESULTS: Data for 39 infants who underwent laparoscopic pyloromyotomy were compared with those for 38 infants who underwent pyloromyotomy via a periumbilical incision. Patient demographics were similar between the two groups. The duration of operation was longer for laparoscopic pyloromyotomy than for the open procedure (median 50 versus 30 min; P = 0.001). There were no differences in recovery time, postoperative length of hospital stay, complication rates and postoperative analgesia requirements between the two groups. CONCLUSION: Laparoscopic pyloromyotomy has been incorporated successfully into the authors' standard working practice. Complication rates recovery times were similar to those achievable with the open procedure. There was no clear benefit of one approach over the other.

Analgesia↗
PubMed2000

[Primary muscular antro-pyloric hypertrophy in the adult: case report].

Primary hypertrophic antro-pyloric stenosis in adults is a misleading anatomic and radioclinical entity. It consists of hypertrophy of the internal muscular layer. Distal gastrectomy is the only effective treatment of the symptomatic form and allows a pathologic study of the gastrectomy, thus ruling out most causes of obstruction, including neoplastic ones. Its congenital origin has not been established. We report the case of a 59 year-old man who had primary hypertrophic pyloric stenosis.

Adult↗
PubMedDate not supplied

[Cystoid pneumatosis of the intestine. Apropos of 2 case reports].

The authors report two cases of pneumatosis cystoides intestinalis involving the small intestine. The first patient, a 35-year-old man treated for duodenal ulcer since 1976, presented with digestive haemorrhage in 1981 for which a vagotomy and a gastroduodenoanastomosis were performed. He was seen in 1986 for a post-bulbar stenosis. On the plain abdomen radiography there were gaseous formations in the sub-phrenic region. At operation the post-bulbar stenosis was confirmed and a cystic pneumatosis interesting 60 cm of the ileum was present. A gastro-enteroanastomosis was performed with an ileal resection and reestablishment of the continuity. He had no recurrence of the disease. The second patient, a 77-year-old man, was admitted for a surgical treatment of a stenosing bulbar ulcer. On the chest X-ray there were many gaseous formations under the diaphragmatic cupula, characteristic of cystic pneumatosis. The surgical exploration confirmed pyloric stenosis for which a vagotomy and a gastroenteroanastomosis were practised; it was found a cystic pneumatosis interesting one meter of the small intestine, which was not resected. The postoperative course was uneventful. The authors review the literature about this benign disease, which can involve the small intestine in case of duodenal or pyloric stenosis. They stress the usefulness of plain radiography of abdomen demonstrating the presence of characteristic gaseous formations in the subphrenic region.

Adult↗