Infantile Pyloric Obstruction

Abstract

In spite of much clinical observation, infantile pylorospasm and pyloric stenosis remain obscure in etiology and in their relationship to each other. Those observers who claim to be able to differentiate between them clinically, by roentgen examination or by both methods, are frequently proved wrong by the clinical course, at operation or at autopsy. Most clinicians include patients with both conditions in the classification of hypertonic infants, since general muscular hypertonus occurs with great frequency in them. Ward,1 who reviewed this subject in 1927, inferred that the only way to differentiate between them is by the end-result. If, on the administration of atropine and on a thick diet, the child improves, the case is one of pylorospasm ; if no improvement follows these measures or if the symptoms continue to grow worse despite them, a diagnosis of organic obstruction is made and operation is advised. At operation a firm muscular mass is found at the pylorus, partially or completely occluding it. The organic change is in itself usually insufficient to cause complete obstruction, but spasm of the muscles and edema of the mucosa and submucosa act as adjuvants and complete it. This pathologic evidence is borne out by the clinical fact that most of these infants take food normally and show normal growth curves for from a few days to a few weeks, when suddenly the symptoms begin. Something of an acute nature must have completed the preexisting partial obstruction. The proportion of functional and organic pathologic change varies in each case and is difficult to determine even by morphologic study. It is therefore advisable to consider both of these types of cases under the heading of "Infantile Pyloric Obstruc¬ tion."From the foregoing summary it can be seen that the vomiting and visible peristalsis common to this disease result from pyloric obstruc¬ tion, either completely spasmodic or combined organic and spasmodic in origin, with the symptoms following completion of the obstruction by the smooth muscle spasm with its accompanying edema and exudation.

A Review of Cow's Milk Allergy in Infancy1

“…The coeliac syndrome and recurrent chronic diarrhoea (Kunstadter & Schultz, 1953) occasionally may be due to cow's milk allergy. Cases of pylorospasm and pyloric stenosis have been reported (Cohen & Breitbart, 1929;Balyeat & Pounders, 1933 McCarthy & Wiesman 1937). Gastro-intes tinal allergy may be associated with an eosinophilia of the stools.…”