Pyloric Stenosis With Azotæmia

Abstract

IN January, 1923, Haden and Orr, in the Bulletin of the Johns Hopkins Hospital, described three cases of acute intoxication following gasrro-enterostomy. They ascribed the symptoms as being due to absorption of a toxin from a closed upper intestinal loop. Later in the same year Brown, Hartman, Eusterman and Rowntree'') described a series of similar cases.In 1928 French writers Blum and Rathery again noted the uraemic changes associated with hypochloramia (ur6mae par manque de sel) . The only reference found in Australian literature is a comprehensive article by Falconer and Lyall, in TEE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURQERY in 1938.(p) They give a good account of symptomatology and point out the advantages of jejunostomy.Apart, then, from the few cases reported i n the surgical literature, very little progress has been made in finding a satisfactory explanation for the syndrome in the past twenty-five years.The four cases reported here were all seen in the past twelve months a t Concord Military Hospital. They were all known cases of duodenal ulceration. Azotamia followed pyloric stenosis due to ulcer in three of the cases, and in the other case followed vagotomy and posterior gastro-enterostomy (Case I11 ) .