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PubMed1986

Reticulo-omasal stenosis in the cow: differential diagnosis with respect to pyloric stenosis.

In the complex called vagal indigestion two main types of stenosis can be distinguished, pyloric stenosis and stenosis between the reticulum and omasum or reticulo-omasal stenosis. Laboratory examinations of blood and rumen fluid were carried out in 10 cows with reticulo-omasal stenosis. The results are discussed with respect to the differential diagnoses of pyloric stenosis. In the cows with reticulo-omasal stenosis no metabolic alkalosis occurred and consequently dehydration and uraemia did not develop. For the clinician valuable points of difference were a more prolonged and chronic course and, on physical examination, the absence of serious circulatory disturbances and the absence of an ammoniacal-uraemic odour in the expired air. The clinical picture of reticulo-omasal stenosis strongly resembles a syndrome described as failure of omasal transport.

Animals↗

PubMed2005

[The etiology and pathogenesis of infantile pyloric stenosis].

As it is known, pyloric stenosis among newborns and infants represents a high or complete obturation caused by stomach circular muscles hypertrophy. This disease is widely spread in the world. According to the reference data, the prevalence of this disease is about one per 200-300 newborns. Despite of the many surveys and investigations, ethiopathogenesis of pylorostenosis remains the issue of debates. Some of the authors consider pyloric stenosis as the innate defect of evolution, while others think that the enlargement of pylorus circular muscles is caused by working hypertrophy. According to our tests performed on the laboratory animals and developed experimental model of the disease, pyloric stenosis may be considered as an inborn pathology. The leading place in its etiology takes the partial impenetrability caused by the swelling of pylorus mucus (allergic, inflammation) and as a consequence development of working hypertrophy.

Animals↗

PubMedDate not supplied

A rare coexistence of two gastric outlet obstructive lesions: infantile hypertrophic pyloric stenosis and organoaxial gastric volvulus.

Infantile pyloric stenosis is one of the most common conditions requiring surgery during the first few weeks of life. The association of infantile pyloric stenosis with gastric volvulus in an extremely uncommon occurrence. A 10-month-old male infant operated for infantile pyloric stenosis at two months of age is presented. His current problem was recurrent pulmonary infections and he was diagnosed to have organoaxial gastric volvulus and gastroesophageal reflux. The common features of presentation, radiological findings, surgical procedures and possible mechanisms of gastric volvulus associated with infantile pyloric stenosis are discussed.

Gastroesophageal Reflux↗

PubMed2004

Pyloric stenosis: unusual presentations and rare assoclations.

Pyloric stenosis is a common paediatric surgical condition with a well-recognised pattern of clinical features. Diagnosis is usually straightforward and a Ramstedt pyloromyotomy is curative. We present three patients who developed pyloric stenosis incidentally during the management of other primary surgical conditions. Issues of diagnostic difficulty following presentation of pyloric stenosis in the post-operative period (all three patients), its rare syndromic associations (one patient) and its management in this unusual situation are discussed. An awareness of the unusual presentations of pyloric stenosis during treatment for other primary surgical conditions can help in earlier diagnosis and treatment.

Congenital Abnormalities↗

PubMed1991

Pyloric stenosis associated with malrotation.

Three cases of pyloric stenosis associated with malrotation are presented. In one case, the diagnosis was made synchronously, and in two cases, pyloric stenosis was noted following correction of malrotation. All three patients underwent pyloromyotomy and Ladd's procedure. These cases differ from the few reported hereditary cases of pyloric stenosis associated with malrotation, which have congenitally shortened bowel, functional obstruction, and poor prognosis. The unusual finding of pyloric stenosis and malrotation occurring together in the first patient was diagnosed with upper gastrointestinal series, obtained because of a high index of suspicion despite a palpable pyloric tumor and positive ultrasound examination. The second and third cases illustrate that vomiting following Ladd's procedure may be due to pyloric stenosis. When clinical findings do not support the presumed diagnosis, further investigation prior to operation is recommended so that rare concommitant pathology can be corrected.

Female↗

PubMed2006

[Acquired non hypertrophic pyloric stenosis in children].

UNLABELLED: Pediatric non hypertrophic pyloric stenosis (NHPS) are uncommon. Their causes and treatments are debated. MATERIAL AND METHOD: Retrospective review of all cases of NHPS from 3 pediatric surgery services during the period 1984-2002. RESULTS: Six children, aged 17 months to 15 years, underwent surgery for NHPS. Clinical symptoms, food vomiting and loss of weight, were present for several weeks before the diagnosis of NHPS was made. The diagnosis was peptic stenosis in 3 cases and has not been established in 3 cases. Search for Helicobacter pylori was negative in all cases. Failure of specific medical treatment and endoscopic dilatations led to pyloric resection in 3 cases and pyloroplasty in 3 cases. Post operative course was uneventful with normal oral feeding and normalisation of weight status. Histologic data were aspecific. No recurrence was observed. DISCUSSION: We discuss the origin of the pyloric stenosis, regarding clinical, operative and pathological data: were the stenosis the cause or consequence of peptic ulcer? Peptic disease is always advocated, but difficult to prove and may be excessively incriminated. Late symptomatic congenital and acquired idiopathic pyloric stenosis should be recalled. In all cases of proved pyloric stenosis, after failure of medical and endoscopic treatment, a simple surgical procedure (pyloroplasty) associated with medical treatment seems to be effective. CONCLUSION: The diagnosis of NHPS should be suspected in a child with food vomiting and loss of weight if his age is not concordant with hypertrophic pyloric stenosis. Upper gastro-intestinal series and endoscopy are diagnostic. The precise cause of the stenosis is more difficult to asses. When the medical treatment fails, a pyloroplasty is usually curative.

Adolescent↗

PubMed2006

Evaluation of a Bayesian decision network for diagnosing pyloric stenosis.

PURPOSE: Most infants undergoing an ultrasound to rule out pyloric stenosis will have a negative study, suggesting the low accuracy of clinical assessment. The purpose of this study was to evaluate the feasibility of using a Bayesian network to improve the accuracy of diagnosing pyloric stenosis. METHODS: Records of 118 infants undergoing an ultrasound to rule out pyloric stenosis were reviewed. Data from 88 (75%) infants were used to train a Bayesian decision network that predicted the probability of pyloric stenosis using risk factors, signs, and symptoms of the disease. The emergency department records of the remaining 28 (25%) infants were used to test the network. Two groups of pediatric surgeons and pediatric emergency medicine physicians were asked to predict the probability of pyloric stenosis in the testing set: (1) physicians using the network and (2) physicians using only emergency department records. Accuracy was evaluated using area under the ROC curve (discrimination) and Hosmer-Lemeshow (H-L) c-statistic (calibration). RESULTS: Physicians using the Bayesian decision network better predicted the probability of pyloric stenosis among infants in the testing set than those not using the network (ROC 0.973 vs 0.882; H-L c-statistic 3.9 [P > .05] vs 24.3 [P < .05]). Physicians using the network would have ordered 22% fewer ultrasounds and missed no cases of pyloric stenosis. CONCLUSIONS: The use of a Bayesian decision network may improve the accuracy of physicians diagnosing infants with possible pyloric stenosis. Use of this decision tool may safely reduce the need for imaging among infants with suspected pyloric stenosis.

Bayes Theorem↗

PubMed1975

Effects of starvation in infancy (pyloric stenosis) on subsequent learning abilities.

The model of starvation in this study was the medical condition of congenital hypertrophic pyloric stenosis. Pyloric stenosis involves a period of brief starvation in early infancy, is unrelated to socioeconomic conditions, and is easily correctable. A number of specific learning abilities together with the general adjustment of 50 subjects, 5 to 14 years old, who had PS were studied and compared to those of 44 siblings and 50 matched controls. Learning ability was negatively correlated with the degree of severity of the starvation. Starvation resulting in reduction of more than 10% of the expected body weight in infancy was associated with poorer learning abilities, especially those involving short-term memory and attention.

Adolescent↗

PubMed1995

Immunochemical characterization of neural cell adhesion molecule (NCAM), nitric oxide synthase, and neurofilament protein expression in pyloric muscle of patients with pyloric stenosis.

The etiology of hypertrophic pyloric stenosis (HPS) is not known. We made an immunocytochemical examination of pyloric muscle from 18 patients with HPS and 10 controls using specific monoclonal antibodies to neural cell adhesion molecule (NCAM) as well as neurofilament protein and NADPH-diaphorase histochemistry. In HPS, bundles of hypertrophic muscle fibers expanded the circular muscle layer. The longitudinal muscle also appeared hypertrophic but to a less marked degree. The most striking difference between HPS and the control tissues was that NCAM, NADPH-diaphorase, and neurofilament protein immunoreactive fibers were absent or markedly reduced within the hypertrophied circular and longitudinal musculature. In contrast, NCAM, NADPH-diaphorase, and neurofilament protein immunoreactivity was preserved in the myenteric plexus where nerve fibers and ganglion cells were stained. The lack of expression of NCAM, NADPH-diaphorase, and neurofilament protein on nerve fibers within the circular and longitudinal muscle in patients with pyloric stenosis suggests that the smooth muscle is not innervated in this condition.

Amino Acid Oxidoreductases↗

PubMed1993

Infantile hypertrophic pyloric stenosis and hydronephrosis: is there an association?

Infantile hypertrophic pyloric stenosis is a common condition requiring surgical intervention during the first few weeks of life. The incidence of infantile hypertrophic pyloric stenosis ranges from 0.13 to 0.4% of live births in the United States, Britain and Scandinavia. Associated anomalies have been described in 6 to 33% of the cases in the central nervous system, gastrointestinal tract and heart. An association of infantile hypertrophic pyloric stenosis with urinary tract anomalies has not been previously documented. A review of 422 patients with infantile hypertrophic pyloric stenosis revealed urinary tract anomalies in 6 (10 renal units), including 4 renal units with vesicoureteral reflux and 9 with hydronephrosis. This incidence of 1.4% is greater than the 0.2% incidence expected in the general population. This 7-fold increase in urinary tract anomalies in patients with infantile hypertrophic pyloric stenosis suggests an association between the two and warrants further investigation. Serious consideration should be given to obtaining renal ultrasound examinations in patients with infantile hypertrophic pyloric stenosis.

Abnormalities, Multiple↗

PubMed1995

The antral nipple sign of pyloric mucosal prolapse: endoscopic correlation of a new sonographic observation in patients with pyloric stenosis.

This study describes the antral nipple sign of pyloric mucosal prolapse, a newly delineated sonographic observation in patients with pyloric stenosis, correlates the endoscopic findings, and examines its prevalence and significance in 31 consecutive patients with pyloric stenosis. Fifty patients who did not have pyloric stenosis served as the control population. The antral nipple sign consists of visualization of prolapsed, hypertrophied pyloric mucosa protruding into the gastric antrum. Using the Wilcoxon scores (rank sums), there was no significant difference among the patients in age, weight, or pyloric muscle dimensions. Although the diagnosis of pyloric stenosis is made on the basis of muscle thickness, we have documented that the pyloric mucosa becomes redundant in infants with pyloric stenosis, permitting a fuller understanding of the anatomic correlate underlying the sonographic images.

Endoscopy, Gastrointestinal↗

PubMed1993

Clinical diagnosis of pyloric stenosis: a declining art.

OBJECTIVE: To assess whether diagnostic imaging of pyloric stenosis has made a difference in rapidity of diagnosis, duration of pre-operative hydration, and length of stay in hospital. DESIGN: Chart review of infants with confirmed diagnosis of pyloric stenosis. SETTING: Paediatric teaching hospital. SUBJECTS: 215 infants with a confirmed diagnosis of pyloric stenosis seen during 1974-7 and 187 infants with pyloric stenosis seen during 1988-91. MAIN OUTCOME MEASURES: State of hydration on admission, time between presentation to hospital and a definite diagnosis, techniques used to make the diagnosis, whether a pyloric mass was felt before or after an imaging procedure, time between presentation and surgery, and length of stay in hospital. RESULTS: The average age at presentation was 40 days in both groups. A pyloric mass was palpated either without or before an imaging study in 87% (187/215) of cases during 1974-7 but in only 49% (91/187) during 1988-91. The use of barium meal examination and ultrasonography increased from 20% (42/215) of cases during 1974-7 to 61% (114/187) during 1988-91. There were no significant differences between the two groups in the time taken to establish a diagnosis, the mean duration of preoperative treatment, or the length of stay in hospital (after allowance for the decline in average length of stay of all hospital patients between the two periods). CONCLUSIONS: An increased use of diagnostic imaging for pyloric stenosis did not lead to earlier diagnosis or better management. While imaging is important in identifying pyloric stenosis in difficult cases, increasing reliance on imaging has reduced doctors' skills in diagnosing pyloric stenosis clinically.

Age Factors↗

PubMed1993

Hypertrophic pyloric stenosis in the newborn.

Hypertrophic pyloric stenosis is exceedingly rare in newborns as well as patients over 6 months of age. These cases likely represent outliers from the normal distribution of its clinical presentation. This is a report of pyloric stenosis in a newborn. A review of the literature is included.

Female↗

PubMed1995

Hypertrophic pyloric stenosis: ultrastructural abnormalities of enteric nerves and the interstitial cells of Cajal.

Dysfunction of pyloric inhibition has been implicated in the pathophysiology of hypertrophic pyloric stenosis. Normal inhibition likely is mediated by peptidergic enteric nerves and also may involve interstitial cells of Cajal (ICC). The authors used electron microscopy to qualitatively assess these structures in infants with pyloric stenosis and in normal controls. Pyloric muscle strips from five infants with hypertrophic pyloric stenosis, from three normal pediatric organ donors, and from three adults were examined. The following observations were made. (1) Muscle cells were primarily in a proliferative phase in pyloric stenosis and exhibited very few gap junctions between smooth muscle cells or ICC compared with the control specimens. (2) The circular muscle layer in pyloric stenosis was characterized by near absence of large granular vesicle-containing nerve fibers compared with the control specimens. (3) There were fewer nerve cell bodies in the myenteric plexus in pyloric stenosis, and the total number of ganglia was lower than that in control samples. (4) Interstitial cells of Cajal were almost completely absent in patients with hypertrophic pyloric stenosis, but there was a group of cells resembling ICC that was termed ICC-like cells. These cells may represent a failure or delay in the maturation process of the ICC. These findings show that there are significant structural abnormalities of the inhibitory nervous system in hypertrophic pyloric stenosis. The ontogenic origins and functional significance of these results require further investigation.

Case-Control Studies↗

PubMed1978

Pyloric stenosis.

In this study, pyloric stenosis appeared to be a commonly occurring, independent, entity probably resulting from antral pyloric canal gastritis rather than from an ulcer crater per se. An appropriate term might be stenosing pyloritis. Intraoperative effects on the pyloric sphincter from glucagon and atropine administration and stimulation of the vagi and gastric pacemaker were not detectable in a limited study on four cases. A local autonomy of sphincteric action was noted which was not affected by trunkal vagotomy.

Atropine↗

PubMed1996

Neonatal hypertrophic pyloric stenosis: congenital or infantile?

Hypertrophic pyloric stenosis (HPS) is very rare during the newborn period. Here we present a fullterm male neonate with abundant hematemesis 12 hours after birth which interrupted oral feeding. Bleeding subsided within three days after conservative measures, and oral feeding was restarted but not tolerated. The vomiting was effortless and nonbilious. An upper gastrointestinal series revealed gastric dilatation and partial obstruction of the gastric outlet. HPS was found by laparotomy on the fourth day and Fredet-Ramstedt pyloromyotomy relieved the gastric emptying. This is one of the few cases of HPS present at birth, which was diagnosed and surgically treated early, and we suggest a congenital etiology in previously reported cases of HPS. Hypertrophic pyloric stenosis (HPS) is a common cause of pediatric surgery. Usually young infants are involved; HPS is extremely rare in neonates and infants older than 6 months. Vomiting typically begins between the 3rd and 6th week of life, although some infants may have mild symptoms like regurgitation from birth.

Adult↗

PubMed1997

The epidemiology of infantile hypertrophic pyloric stenosis.

Infants with infantile hypertrophic pyloric stenosis (IHPS) born from 1983 to 1988 and recorded in the California Birth Defects Monitoring Program (CBDMP) database were compared with their birth cohort by demographic characteristics and selected associated birth defects. We identified 1963 cases of IHPS for a cumulative incidence of 1.9 per 1000 livebirths. The cumulative incidence per 1000 livebirths was 2.4 in White, 1.8 in Hispanic, 0.7 in Black, and 0.6 in Asian infants. Between weeks 3-12 after birth, 1871 (95%) IHPS cases were diagnosed. Premature infants were diagnosed with IHPS later than term or post-term infants. The incidence of IHPS declined for those born to maternal age groups of > or = 25 years and, independently, for successive birth ranks. The probandwise concordance rate for IHPS in monozygous twins was less than unity (0.25-0.44), although higher than the concordance for dizygous twins (0.05-0.10). The incidence of Smith-Lemli-Opitz syndrome (SLO) diagnosed in infants with IHPS (3 of 1963) was 157-fold higher than the incidence of SLO diagnosed in the CBDMP population. IHPS occurs in all of the largest racial and ethnic groups in California, most frequently in White and Hispanic infants. Pyloric stenosis presents only within a brief phase of development, which may be delayed in premature infants. A predominant discordance of disease state in monozygous twins implies an aetiological role for undetermined environmental factors. The association between SLO, caused by deficient cholesterol synthesis, and IHPS deserves additional study. Infants with suspected SLO require close observation for the onset of IHPS.

Abnormalities, Multiple↗

PubMed2006

Portal venous gas in hypertrophic pyloric stenosis.

Portal venous gas associated with hypertrophic pyloric stenosis is a rare finding. We describe an atypical radiologic finding discovered on abdominal ultrasound and computed tomographic scan in an infant with hypertrophic pyloric stenosis. Portal venous gas in the setting of hypertrophic pyloric stenosis constitutes a benign incidental finding for which surgical treatment should not be postponed.

Embolism, Air↗