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Journal of Clinical Pathology Jun 1998A case of adult hypertrophic pyloric stenosis presented in an older female with no apparent predisposing factors which might be likely to precipitate the condition.... (Review)
Review
A case of adult hypertrophic pyloric stenosis presented in an older female with no apparent predisposing factors which might be likely to precipitate the condition. There was a history of chronic dyspepsia and occasional episodes of vomiting. No contributory medical history was identified. Barium swallow and follow through showed a markedly reduced emptying time of the stomach. A partial gastrectomy was eventually done and on histopathological examination a diagnosis of adult hypertrophic pyloric stenosis was made.
Topics: Female; Gastric Emptying; Humans; Hypertrophy; Middle Aged; Pyloric Stenosis; Pylorus
PubMed: 9771452
DOI: 10.1136/jcp.51.6.479 -
Scientific Reports Aug 2017Congenital Hypertrophic Pyloric Stenosis (CHPS) is a disease condition that is caused as a result of pylorus wall hypertrophy and hyperplasia. In this study, we used...
Congenital Hypertrophic Pyloric Stenosis (CHPS) is a disease condition that is caused as a result of pylorus wall hypertrophy and hyperplasia. In this study, we used color Doppler flow imaging (CDFI) and Doppler artifacts technique to observe the blood flow of hypertrophic pylorus tissue and the dynamic imaging of liquid passing through the pyloric canal in CHPS infants. 65 cases of CHPS infants and 50 infants without CHPS served as control group. We found that there were statistically significant differences between the blood flow grade of muscular layer and mucosal layer between CHPS and control infants, but no significant differences were observed in the same group. Doppler artifacts technique demonstrated the whole process of contrast agent flow through pyloric canal was directly observed in 35 of 65 subjects, and the internal diameter of the pyloric canal was 1.93 ± 0.33mm.Conclusion that CDFI combined with color Doppler artifacts technique was proved to be effective to observe the distribution feature and blood flow grade in each layer of pyloric canal in CHPS patients. This method provides the evidence for judging the degree of pyloric stenosis clinically, and furnishes the basis of therapy along with its clinical significance and good application value.
Topics: Biomarkers; Case-Control Studies; Female; Humans; Image Processing, Computer-Assisted; Infant; Infant, Newborn; Male; Pyloric Stenosis, Hypertrophic; Ultrasonography, Doppler, Color
PubMed: 28842652
DOI: 10.1038/s41598-017-10264-7 -
ANZ Journal of Surgery May 2022Our aims were to determine if the diagnostic threshold for diagnosing hypertrophic pyloric stenosis (HPS) on ultrasound scan (USS) should be adjusted based on birth...
BACKGROUND
Our aims were to determine if the diagnostic threshold for diagnosing hypertrophic pyloric stenosis (HPS) on ultrasound scan (USS) should be adjusted based on birth weight (BW), current weight (CW), gestational age (GA), chronological age (CA) or corrected gestational age (CGA).
METHODS
All patients who underwent either an USS and pyloromyotomy (Group 1) or an USS for possible HPS (Group 2) at our tertiary centre between July 2013 and June 2019 were identified. Ideal threshold values are identified by measuring Youden's Index (J = sensitivity + specificity - 1; higher is better). Mean maximum Youden's Index for stratified results was compared to that for combined results.
RESULTS
Two hundred and eighty-four patients were included (142 patients in both Group 1 and Group 2). Combined maximum Youden's Index for all patients was 0.92 for pyloric canal thickness (PMT) and 0.87 for pyloric canal length (PCL). Mean maximum Youden's Index was higher when patients were stratified by GA, CGA, BW or CW, and equivalent for CA. For pyloric canal length (PCL), mean maximum Youden's Index was lower for all variables when stratified compared to combined. There was no visual trend observed in the diagnostic thresholds between groups.
CONCLUSION
Stratifying USS PMT diagnostic thresholds values based on age and weight is statistically more accurate than a single threshold in diagnosing HPS. However, the lack of visual correlation indicates a larger dataset is required to validate these results.
Topics: Constriction, Pathologic; Humans; Infant; Pyloric Stenosis, Hypertrophic; Pyloromyotomy; Pylorus; Ultrasonography
PubMed: 35393697
DOI: 10.1111/ans.17649 -
Paediatric Anaesthesia Apr 2021Thoracic epidural anesthesia for open infantile hypertrophic pyloric stenosis surgery is a controversial issue in the presence of little comparative data. (Observational Study)
Observational Study
BACKGROUND
Thoracic epidural anesthesia for open infantile hypertrophic pyloric stenosis surgery is a controversial issue in the presence of little comparative data.
AIMS
To compare this approach to general anesthesia for desaturation events (≤90% oxygen saturation) and absolute values of minimal oxygen saturation, minimal heart frequency, operating-room occupancy time, and durations of surgery in a retrospective study design.
METHODS
Data were retrieved for patients with infantile hypertrophic pyloric stenosis managed by thoracic epidurals under sedation or general anesthesia with rapid sequence induction between 01/2007 and 12/2017. Oxygen saturation and heart rate were analyzed over eight 5-minutes intervals relative to the start of anesthesia / sedation (four-time intervals) and before discharge of the patient from the operating room (four-time intervals). Fisher's exact tests and mixed model two-way analysis of variance for repeated measures were employed for intergroup comparisons.
RESULTS
The epidural and general anesthesia groups included 69 and 32 evaluable infants, respectively. Patients managed under epidural anesthesia had cumulatively higher minimimal mean (SD) oxygen saturation values (98.2 [2.6] % versus 96.6 [5.2] %, p < 0.001) and lower minimal mean (SD) heart rate values (127.9 [15.0] beats per minute versus 140.7 [17.2] beats per minute, p < 0.001) over time. Similarly, the frequency of desaturation events (defined as ≤90% oxygen saturation) was significantly lower for these patients during the period of 5 minutes after induction of sedation or general anesthesia (odds ratio 7.4 [2.1-25.9]; p = 0.001) and during the subsequent period of five minutes (odds ratio 6.2 [1.1-33.9]; p = 0.031). One case of prolonged respiratory weaning was observed in the general anesthesia group. The mean (SD) operating-room occupancy was 61.9 (16.6) minutes for the epidural anesthesia group versus 73.3 (22.2) minutes for the general anesthesia group (p = 0.005) as a result of shorter emergence from sedation.
CONCLUSIONS
In our series, maintaining spontaneous breathing with minimal airway manipulation in patients undergoing open repair of hypertrophic pyloric stenosis under single-shot epidural anesthesia resulted in fewer desaturation events ≤90% than general anesthesia. In addition, this approach seems to result in shorter turnover times in the operating room.
Topics: Anesthesia, Epidural; Anesthesia, General; Epidural Space; Humans; Infant; Pyloric Stenosis, Hypertrophic; Pyloromyotomy; Retrospective Studies
PubMed: 33368903
DOI: 10.1111/pan.14114 -
California Medicine May 1959Hypertrophic pyloric stenosis, a relatively common condition, is caused by hyperplasia of the musculature of the pylorus. The diagnosis is made by a history of...
Hypertrophic pyloric stenosis, a relatively common condition, is caused by hyperplasia of the musculature of the pylorus. The diagnosis is made by a history of projectile vomiting and failure to gain weight, the observation of gastric peristaltic waves, and the palpation of a pyloric “tumor.” A method of palpating this tumor is described in detail. Roentgenological studies are rarely indicated. Pylorotomy for treatment of hypertrophic pyloric stenosis was not successful until the development of necessary supporting measures. Preparation for operation consists of intravenous administration of fluids and electrolytes and sometimes serum or whole blood. The position of the tumor governs the choice between two different incisions. The operative procedure herein described is essentially that devised by Ramstedt many years ago, with modifications to facilitate the procedure.
Topics: Body Fluids; Body Weight; Choice Behavior; Emotions; Feces; Government; Humans; Hyperplasia; Infusions, Intravenous; Orthotic Devices; Palpation; Pyloric Stenosis, Hypertrophic; Pylorus; Vomiting
PubMed: 13651960
DOI: No ID Found -
Cureus Jun 2022Gastric outlet obstruction (GOO) is unusual and must be suspected in children with chronic vomiting and abnormal weight status. The treatment depends on etiology, and...
Gastric outlet obstruction (GOO) is unusual and must be suspected in children with chronic vomiting and abnormal weight status. The treatment depends on etiology, and surgery is not always the first remedy. Diagnosis is easily confirmed by upper gastrointestinal fibroscopy.We report the case of an 11-year-old girl, who was presented with non-bilious emesis and weight loss. Abdominal computed tomography, ultrasound, and upper gastrointestinal fibroscopy showed dilated stomach with pyloric stenosis, which was confirmed by abdominal laparoscopic exploration and cured by Heineke-Mikulicz pyloroplasty. We also compare our study to previously reported cases.
PubMed: 35836464
DOI: 10.7759/cureus.25876 -
African Journal of Paediatric Surgery :... 2022Previous studies demonstrated faster correction of metabolic derangement associated with hypertrophic pyloric stenosis with pre-operative intravenous (IV) histamine-2...
CONTEXT
Previous studies demonstrated faster correction of metabolic derangement associated with hypertrophic pyloric stenosis with pre-operative intravenous (IV) histamine-2 receptor antagonists.
AIMS
We investigated if similar outcomes are achieved with IV pantoprazole, a proton-pump inhibitor (PPI), including the subgroup of delayed presenters in the South African setting.
SETTINGS AND DESIGN
A 5-year retrospective record review (January 2014-December 2018) compared the rate of metabolic correction in patients with hypertrophic pyloric stenosis at two tertiary centres.
SUBJECTS AND METHODS
One centre routinely administers IV pantoprazole (1 mg/kg daily) preoperatively (PPI group) and the other does not (non-PPI group). Fluid administration, chloride supplementation and post-operative emesis were evaluated.
STATISTICAL ANALYSIS
Spearman's rank correlation coefficient was used to calculate statistical significance for discrete dependent variables. Continuous variables were compared between the groups using the Student t-test. Fisher's exact contingency tables were used to classify categorical data and to assess the significance of outcome between two treatment options. P < 0.05 was considered statistically significant.
RESULTS
Forty-two patients received IV pantoprazole and 24 did not. The mean time of metabolic correction was 8 h shorter in the PPI group (P = 0.067). Total pre-operative chloride administration correlated to the rate of metabolic correction in both cohorts (P < 0.0001). Profound hypochloraemia (chloride <85 mmol/l) was corrected 23 h faster in the PPI group (P < 0.004). Post-operative emesis was noted: 0.45 episodes/patient in the PPI group and 0.75 episodes/patient in the non-PPI group (P = 0.01).
CONCLUSIONS
Pre-operative IV pantoprazole administration showed a faster correction of metabolic derangements, and in profound hypochloraemia, the correction occurred substantially faster in the PPI group. Post-operative emesis was significantly less frequent in the PPI group.
Topics: Humans; Pantoprazole; Pyloric Stenosis, Hypertrophic; Retrospective Studies
PubMed: 34916353
DOI: 10.4103/ajps.AJPS_9_21 -
Journal of the American Veterinary... Mar 2013A 5-month-old 1.9-kg (4.2-lb) spayed female Siamese cat was evaluated because of a history of decreased appetite, regurgitation, vomiting, and lack of weight gain.
CASE DESCRIPTION
A 5-month-old 1.9-kg (4.2-lb) spayed female Siamese cat was evaluated because of a history of decreased appetite, regurgitation, vomiting, and lack of weight gain.
CLINICAL FINDINGS
Radiographic findings included a fluid- and gas-distended stomach with a small accumulation of mineral opacities. Ultrasonographic examination confirmed severe fluid distention of the stomach with multiple hyperechoic structures present and revealed protrusion of the thickened pylorus into the gastric lumen, with normal pylorogastric serosal continuity. Endoscopy of the upper gastrointestinal tract revealed an abnormally shortened pyloric antrum and stenotic pyloric outflow orifice. Pyloric stenosis resulting in pyloric outflow obstruction was diagnosed.
TREATMENT AND OUTCOME
A pylorectomy with end-to-end gastroduodenostomy (Billroth I procedure) was successfully performed, and a temporary gastrostomy tube was placed. Six days after surgery, the cat was eating and drinking normally, with the tube only used for administration of medications. The gastrostomy tube was removed 12 days after surgery. Results of follow-up examination by the referring veterinarian 3 weeks after surgery were normal. Occasional vomiting approximately 2 months after surgery was managed medically. Fifteen months after surgery, the owners reported that the cat seemed completely normal in appearance and behavior.
CLINICAL RELEVANCE
Pyloric stenosis should be considered a differential diagnosis for young cats with pyloric outflow obstruction. The cat of this report was treated successfully with a Billroth I procedure. Histologic examination and immunohistochemical analysis of the excised tissue showed the stenosis to be associated with hypertrophy of the tunica muscularis.
Topics: Animals; Cat Diseases; Cats; Digestive System Surgical Procedures; Female; Pyloric Stenosis
PubMed: 23445290
DOI: 10.2460/javma.242.6.792 -
Gut Jul 1971
Review
Topics: ABO Blood-Group System; Alkaline Phosphatase; Blood Group Antigens; Celiac Disease; Cholelithiasis; Colitis, Ulcerative; Crohn Disease; Deficiency Diseases; Duodenal Ulcer; Esophageal Neoplasms; Gastric Juice; Gastrointestinal Diseases; Glycoside Hydrolases; Humans; Hyperbilirubinemia, Hereditary; Intestinal Polyps; Liver Diseases; Megacolon; Pancreatitis; Pyloric Stenosis; Stomach Ulcer
PubMed: 4934411
DOI: 10.1136/gut.12.7.592 -
Pediatric Surgery International May 2021Some paediatric surgical diseases showed a declining incidence in recent years, among which hypertrophic pyloric stenosis has been particularly striking shortly in the... (Review)
Review
PURPOSE
Some paediatric surgical diseases showed a declining incidence in recent years, among which hypertrophic pyloric stenosis has been particularly striking shortly in the years after the millennium. We aimed to assess whether this development continued over the following decade, as it might offer the chance to better understand the underlying reasons.
METHODS
We analysed data files obtained from the German federal statistics office for principal diagnosis of hypertrophic pyloric stenosis and pyloromyotomies from 2005 to 2017. Changes over time were assessed via linear regression for incidences per 1000 live births.
RESULTS
In the respective time interval, there were a mean of 1009 pyloromyotomies (95% CI 906-1112) per year, of which a mean of 835 (95% CI 752-917) were performed in boys. The incidence of hypertrophic pyloric stenosis per 1000 live births almost halved between 2005 and 2017: it decreased by 0.12 pylorotomies annually (95% CI 0.09-0.14; P < 0.0001) in boys-from a maximum of 2.96 to a minimum of 1.63-and 0.03 pyloromyotomies annually (95% CI 0.02-0.04; P < 0.0001) in girls-from a maximum of 0.64 to a minimum of 0.28. There was considerable regional variation in incidences between the German länder.
CONCLUSION
The decreasing incidence of hypertrophic pyloric stenosis noted around the millenium continued into the following decades. The underlying reasons are unclear, which should prompt further research on the subject matter.
Topics: Female; Germany; Health Services; Humans; Hypertrophy; Incidence; Infant; Infant, Newborn; Male; Pediatrics; Probability; Pyloric Stenosis, Hypertrophic; Pyloromyotomy
PubMed: 33469698
DOI: 10.1007/s00383-020-04810-0