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At least 19 recordsLinked to original sources
PubMed1998

Ultrasonography of pylorospasm: findings may simulate hypertrophic pyloric stenosis.

We compared sonographic images and measurements of patients diagnosed as having hypertrophic pyloric stenosis and pylorospasm among infants with projectile vomiting. Thirty-seven patients with hypertrophic pyloric stenosis had an unchanged pyloric length (mean, 22.5 mm) and muscle wall thickness (mean, 5.3 mm). Thirty-four pylorospasm patients had considerable variability in measurement or image appearance during their studies. Means of their longest or largest measurements were 14.4 mm for pylorus length and 3.8 mm for muscle wall thickness. Among these, 53% had muscle wall thickness of 4 mm or greater and 18% had pyloric length of 18 mm or greater during some portion of their study. We concluded (after clinical follow-up study confirmed our ultrasonographic diagnoses) that pylorospasm may mimic hypertrophic pyloric stenosis for at least a portion of a sonographic study. Muscle wall thickness or pyloric length measurements may overlap those accepted as positive for hypertrophic pyloric stenosis. Image or measurement variability is an important clue for diagnosing pylorospasm.

Diagnosis, Differential↗
PubMed2004

The sonographic double-track sign: not pathognomonic for hypertrophic pyloric stenosis; can be seen in pylorospasm.

OBJECTIVE: The "double-track" sign has previously been reported as specific for hypertrophic pyloric stenosis when noted on an upper gastrointestinal series. The sign has been noted on sonographic examinations as well. We sought to determine whether this sign can also be seen in cases of pylorospasm diagnosed by sonography, proving it not to be pathognomonic for hypertrophic pyloric stenosis. METHODS: The data obtained prospectively from 91 consecutive patients studied between 1999 and 2002 by sonography for projectile vomiting were retrospectively reviewed. Cases with diagnoses of hypertrophic pyloric stenosis or pylorospasm were reviewed for the imaging finding of the double-track sign. RESULTS: Thirty-seven patients had a sonographic diagnosis of hypertrophic pyloric stenosis that was confirmed surgically. Twenty-six (70.2%) showed a sonographic double-track sign. Thirty-four patients had a sonographic diagnosis of pylorospasm that was confirmed by close clinical follow-up. Eighteen (52.9%) showed a sonographic double-track sign. CONCLUSIONS: The sonographic double-track sign can be seen in cases of pylorospasm as well as hypertrophic pyloric stenosis. It is not pathognomonic for hypertrophic pyloric stenosis.

Humans↗
PubMed1981

Short segment pyloric narrowing. Pylorospasm or pyloric stenosis?

Short segment narrowing of the pyloric canal is a common finding in infants with chronic vomiting, and most often is due to pylorospasm. In such cases, it is transient, and offers no real problem in diagnosis. On the other hand, when it persists, a question arises as to whether it is due to fixed stenosis. Differentiation of the two conditions is difficult, but important, for while spasm can be treated medically, true stenosis requires surgical intervention. Just how to accomplish this differentiation is the subject of this report, and for the most part, centers around the infant's response to a therapeutic trial of antispasmodics. Patients with pylorospasm respond favorably, while those with fixed stenosis do not. Generally, these latter patients require pyloromyotomy, but in the occasional infant, so little muscle hypertrophy is present that we have found pyloroplasty to be the preferred procedure.

Diagnosis, Differential↗
PubMed2005

Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy?

BACKGROUND: Delayed gastric emptying (DGE) occurs in 14% to 61% of patients after pylorus-preserving pancreaticoduodenectomy, but its pathogenesis is unclear. We hypothesized that DGE may be due to pylorospasm secondary to vagal injuries at operation and may be preventable by the addition of pyloromyotomy. METHODS: Patients operated on consecutively between April 2000 and August 2003 were studied. Pyloromyotomy was of the Fredet-Ramstedt type combined with antroplasty. DGE-free recovery was defined as tolerance of a diet for three successive days by postoperative day 8. The symptom of nausea was used as a basis for nasogastric tube removal and diet resumption. A gastric emptying test (GET) with solid food was obtained. Patients with difficulty swallowing were fed via a feeding tube. RESULTS: There were 47 patients. Two patients were excluded because of death (n = 1) and ileus with pancreatic fistula (n = 1). Diagnoses were pancreatic cancer (n = 23), chronic pancreatitis (n = 11), ampullary cancer (n = 5), mucinous cystic neoplasm (n = 5), and duodenal villous adenoma (n = 3). Median times to nasogastric tube removal, start of liquid diet, and start of solid diet were postoperative days 2, 3, and 5, respectively. Two patients had tube feedings. Preoperative GET was abnormal in 51%, and postoperative GET was abnormal in 37%. The average length of stay was 9.5 days (median, 7 days). DGE occurred in only one patient (2.2%). There were no late complications during a 6-month follow-up. CONCLUSIONS: The addition of pyloromyotomy to pylorus-preserving pancreaticoduodenectomy is effective in preventing DGE. Results are supportive of the hypothesis that DGE may be caused by operative injuries of the vagus innervating the pyloric region.

Adult↗
PubMed1975

[Retrospective study of congenital hypertrophic pyloric stenosis and pylorospasm: Surgical vs. non-surgical treatment (author's transl)].

Congenital hypertrophic pyloric stenosis and pylorospasm have extensively been studied in 705 infants treated in 5 pediatric clinics in Hamburg, W.-Germany, during 1961 to 1970. With this report and its statistical evaluation we are aiming to provide basical information to answer the question still open to discussion: Are we allowed to demand surgical treatment in every single case of spastic hypertrophic pyloric stenosis? The following questions have been investigated: distribution of cases due to grade of severity; frequency of surgical and non-surgical, conservative treatment in these groups of different severity; its rate of success and of fatal outcome; length of clinical treatment and hospitalization; frequency of additional, intercurrent disease in both groups, with and without abdominal surgery; complications during and after surgery; late complications with regard to the way of treatment. From our results we conclude that surgical intervention is indicated in severe cases and in cases of medium severity, together amounting to 60% of all cases. In less severe, about 40%, cases non-surgical, conservative treatment is promising in almost all cases. The most important parameter to single out these less severe cases besides the general status is the roetgenologic finding that delayed emptying of the stomach starts within 15 to 20 min. Important as well is a balanced electrolyte and acid-base metabolism. Once more we advocate individual and subtle decision of paramount surgical intervention, reasoning from the background of this study where the percentage of infants successfully treated by non-surgical, conservative medical ways is very high.

Acid-Base Equilibrium↗