Hiatus Hernia, Pyloric Muscle Hypertrophy and Contracted Pyloric Segment in Adults

Keet, Albertus D.; Heydenrych, J. J.

doi:10.2214/ajr.113.2.217

Cited by 13 publications

(1 citation statement)

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“…The secretion of these hormones, in turn, is stimulated by gastric acid secreted by the parietal cells of the stomach, and many infants with HPS have been documented to have increased parietal cell mass [ 16]. Secretion of excess gastrin and vagal overstimulation have also been implicated in the etiology of HPS, both having been shown to induce pyloric muscle spasm and subsequent hypertrophy [4,11,12,18]. Exogenous causes of liPS have also been documented, as in the case of five newborns who developed vomiting with pylorospasm following the administration of erythromycin estolate, which over a period of days developed into HPS [17].…”

Section: Discussionmentioning

confidence: 99%

Pyloric stenosis: evolution from pylorospasm?

1990

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Over a 10-year period, we have performed pyloromyotomy on 260 infants with hypertrophic pyloric stenosis (HPS), 10 of whom had a history suggestive of pyloric stenosis but initially had neither the physical nor radiological findings to confirm the diagnosis. All 10 demonstrated pylorospasm on upper gastrointestinal series (UGIS), were treated medically without improvement, and subsequently developed classic HPS confirmed by repeat UGIS. Age at diagnosis ranged from 3 to 16 weeks (mean 8 weeks). Vomiting was progressively more projectile and severe from the onset until diagnosis and operation, with a duration of 5-5 0 days (mean 24 days). In 9 of the 10 patients a second UGIS demonstrated the diagnostic signs of HPS in 8 and suggested an antral web in the 9th. The interval between the two UGIS ranged from 2 to 46 days (mean 13 days). The 10th patient had a palpable hypertrophic pyloric muscle 9 days after the first UGIS and was operated upon without a follow-up UGIS. All 10 patients had classic HPS at operation. We conclude that although most infants with pylorospasm on UGIS improve with medical management, a small but significant number go on to develop HPS. Awareness of this variant of pyloric stenosis and appropriate follow-up UGIS will help to avoid undue delay in correctly diagnosing infants with persistent non-bilious vomiting.

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Section: Discussionmentioning

confidence: 99%