Research progress in anti-reflux reconstructions and mechanism after proximal gastrectomy / 中华胃肠外科杂志

The electrophysiological activity of the gastrointestinal tract and the mechanical anti-reflux structure of the gastroesophageal junction are the basis of the anti-reflux function of the stomach. Proximal gastrectomy destroys the mechanical structure and normal electrophysiological channels of the anti-reflux. Therefore, the residual gastric function is disordered. Moreover, gastroesophageal reflux is one of the most serious complications. The emergence of various types of anti-reflux surgery through the mechanism of reconstructing mechanical anti-reflux barrier and establishing buffer zone, and the preservation of, the pacing area and vagus nerve of the stomach, the continuity of the jejunal bowel, the original gastroenteric electrophysiological activity of the gastrointestinal tract, and the physiological function of the pyloric sphincter, are all important measures for gastric conservative operations. There are many types of reconstructive approaches after proximal gastrectomy. The design based on the anti-reflux mechanism and the functional reconstruction of mechanical barrier, and the protection of gastrointestinal electrophysiological activities are important considerations for the selected of reconstructive approaches after proximal gastrectomy. In clinical practice, we should consider the principle of individualization and the safety of radical resection of tumor to select a rational reconstructive approaches after proximal gastrectomy.

Current status of lymph node dissection in pyloric-preserving gastrectomy for early gastric cancer / 中华胃肠外科杂志

With the gradual increase in the diagnosis rate of early gastric cancer, clinicians must consider prevention of gastric anatomical structure and physiological function while ensuring the radical treatment of the tumor. Pylorus-preserving gastrectomy is a function- preserving operation that preserves the pylorus, inferior pyloric vessel, and the vagus nerve in patients with early middle gastric cancer. One of the major controversies at present is the thoroughness of limited lymph node dissection for pyloric-preserving gastrectomy. Various studies have reported that the lymph node metastasis rate of early middle gastric cancer was low, especially in the suprapyloric region, inferior pylorus and the upper pancreatic region. Partial lymph node dissection is required for vascular and neurological protection, which is also safe and feasible in studies reported by major centers. Many clinical studies have been carried out in Japan and Korea, and postoperative follow-up has gradually increased evidence, providing the basis for the safety of lymph node dissection. In large case studies comparing pylorus- preserving gastrectomy with traditional distal gastrectomy, the incidence of postoperative morbidity, such as dumping syndrome, bile reflux esophagitis, weight loss, and malnutrition is low. Sentinel lymph node navigation technology is gradually applied to the diagnosis and treatment of early gastric cancer, and its clinical application value still needs further research.

Píloro doble: de lo cotidiano a lo extraordinario: reporte de caso y revisión de la literatura / Double pylorus: from the everything to the extraordinary: case report and literature review

Antecedentes: El píloro doble constituye un hallazgo endoscópico extremadamente raro, siendo más frecuente en pacientes que padecen enfermedad ulcerosa péptica. Corresponde a una comunicación anormal entre el antro gástrico y el bulbo duodenal, que puede llegar a requerir tratamiento quirúrgico. Caso clínico: Mujer de 86 años de edad con antecedentes de diabetes mellitus tipo 2, hipertensión arterial, así como ingesta crónica de AINE, portadora de enfermedad ácido-péptica de larga evolución con poca respuesta al manejo médico con bloqueadores H2, la cual presenta sangrado de tubo digestivo durante 5 días caracterizado por hematemesis y melena, así como pirosis, náuseas, sin pérdida ponderal; por este motivo se realiza endoscopia digestiva alta la cual reporta como hallazgos: gastritis erosiva crónica activa secundaria a AINE y asociada a Helicobacter pylori, así como píloro doble adquirido secundario a enfermedad ácido-péptica, sin evidencia de tumores u otras lesiones asociadas. Se inicia esquema de erradicación para H. pylori con amoxicilina y claritromicina durante 14 días, asociados a inhibidor de bomba de protones durante 6-8 semanas con buena respuesta al manejo médico. Discusión: El píloro doble adquirido es una rara complicación de úlcera péptica que puede ser asociada a otras enfermedades, AINE y a la colonización por H. pylori, por lo tanto el adecuado tratamiento consistirá en la corrección de esos factores.

Background: The double pylorus is an extremely rare endoscopic finding, being more frequent in patients suffering from peptic ulcer disease. It corresponds to an abnormal communication between the gastric antrum and the duodenal bulb, which may require surgical treatment. Clinical case: A 86-year-old woman with a history of type 2 diabetes mellitus, hypertension and chronic NSAID intake, a carrier of long-term peptic acid disease with poor response to medical management with H2 blockers. This presents digestive tube bleeding for 5 days characterized by hematemesis and melena, as well as heartburn, nausea, without weight loss, reason why high digestive endoscopy is performed, which reports as findings: active chronic erosive gastritis secondary to NSAIDs and associated with Helicobacter pylori, as well as acquired double pylorus secondary to peptic acid disease, without evidence of tumors or other associated lesions. Eradication scheme begins for H. pylori with amoxicillin and clarithromycin for 14 days, associated with a proton pump inhibitor for 6-8 weeks with good response to medical management. Discussion: The acquired double pylorus is a rare complication of peptic ulcer disease that can be associated with other diseases, NSAIDs and colonization by H. pylori, therefore the appropriate treatment will consist in the correction of these factors.

Neurofibroma plexiforme solitário determinando obstrução pilórica: relato de caso / Solitary plexiform neurofibroma determining pyloric obstruction: a case report

Solitary gastric plexiform neurofibroma (PN) is a very rare tumor that originates from the peripheral nerves. PN is a rare cause of pyloric obstruction. A 58 year-old man, reported epigastric discomfort, nausea, and vomiting for two months. Upper digestive endoscopy showed a moderate/accentuated pyloric stenosis. Computed tomography (CT) and echoendoscopy revealed a pyloric nodule. The patient underwent to distal gastrectomy. Macroscopically, a gray nodule measuring 1.1 × 1.0 × 1.0 cm was identified. Using microscopy, a benign tumor composed of enlarged tortuous nerve fascicles showing a neurofibromatous proliferation with mild atypia and myxoid matrix was found. The lesion showed positive immunoexpression for S100, Leu7, and epithelial membrane antigen (EMA), and was negative for CD117, DOG-1, desmin, and smooth muscle actin. The diagnosis of PN was then determined...

Neurofibroma plexiforme (NP) gástrico solitário é um tumor muito raro originado a partir dos nervos periféricos. É uma causa rara de obstrução pilórica. Paciente masculino, 58 anos, relatava desconforto epigástrico, náuseas e vômitos durante dois meses. A endoscopia digestiva superior mostrou estenose moderada/acentuada do piloro. Tomografia computadorizada (TC)/ ecoendoscopia revelaram nódulo no piloro. O paciente foi submetido a gastrectomia distal. À macroscopia, identificou-se nódulo cinzento medindo 1.1 × 1 × 1 cm. À microscopia, encontrou-se tumor benigno composto por fascículos nervosos dilatados/ tortuosos, exibindo proliferação neurofibromatosa com atipias leves e matriz mixoide. A lesão exibiu imunoexpressão positiva para S100, Leu7 e antígeno da membrana epitelial (EMA), e negatividade para CD117, DOG-1, desmina e actina de músculo liso. O diagnóstico de PN foi, então, determinado...

Late administration of a specific COX-2 inhibitor does not treat and/or prevent progression of gastric tumors in rats submitted to duodenogastric reflux procedure

PURPOSE:To assess whether late introduction of a specific COX-2 inhibitor (Meloxicam) can treat and/or prevent the progression of tumors in the stomach of rats submitted to duodenogastric reflux. METHODS: Seventy five male Wistar rats, weighing 150 grams, were submitted to the induction of duodenogastric reflux through the pylorus. At 36 weeks of follow-up were established three experimental groups: DGR36 sacrificed immediately, DGR54 and DGR54MLX both sacrificed at 54th week of follow-up . The animals of the latter group were fed with a rat chow premixed with Meloxicam (2.0 mg/ kg feed; 0.3 mg / kg bw / day) and the other two with standard rat chow. The lesions found in the pyloric mucosa and gastrojejunal anastomosis were analyzed macroscopically and histologically. For statistical analysis was adjusted a generalized linear model assuming a binomial distribution with LOGIT link function. RESULTS: No significant differences were found when comparing the incidences of benign tumor lesions (Adenomatous Hyperplasia), p=0.4915, or malignant (Mucinous Adenocarcinoma), p=0.2731, among groups. CONCLUSION: Late introduction of specific COX-2 inhibitor (Meloxicam) did not treat and was not able to prevent the progression of tumoral lesions induced by duodenogastric reflux in the rat stomachs.

Ultrasonographic findings of pylorogastric intussusceptions in two dogs

A Yorkshire terrier (case 1) and a Miniature Schnauzer (case 2) were diagnosed with pylorogastric intussusceptions (PGIs). Both cases showed acute vomiting and had previous histories of laparotomy. In case 1, the invaginated pyloric wall was thickened unevenly containing multiple hypoechoic areas and had indistinct wall layering on ultrasonography. PGI with diffuse gastric edema and necrosis was confirmed on laparotomy. The dog recovered completely after gastrectomy and a Y-U plasty. Case 2 had uniformly thickened walls of invaginated gastric pylorus with the distinct wall layering. PGI was reduced spontaneously the next day.

The morphological effects of asthma, as well as conventional and alternative asthma therapies on parietal and chief cells in the stomach of BALB/c Mice / Los efectos morfológicos del asma, así como de las terapias convencionales y alternativas del asma sobre las células parietales y principales en el estómago de ratones Balb/c

Scientific literature, although limited in this area, supports the hypothesis that asthma, by means of selective leukocyte trafficking between the various mucosal and glandular sites of the body, can have the same pathophysiological effects on the stomach as the airways. This study aimed to determine if asthma, in the absence and presence of various asthma therapies (Hydrocortisone and Modul8TM), imparted any morphological alteration on the stomach parietal and chief cells. The BALB/c murine asthmatic mouse model was the model of choice in this study. The asthma induction protocol as well as the asthma therapies were proved to be effective with the aid of bronchial lavage fluid leukocyte quantification. Fundic and pyloric biopsies were extracted at termination and assessed by means of transmission electron, scanning electron and light microscopy. The extracted fundic and pyloric biopsies revealed asthma alone induced parietal cell hypertrophy (increase in parietal cell size P < 0.000100 in both stomach regions) and chief cell hyper functioning. The use of Hydrocortisone and Modul8TM, as a therapy to correct the perceived gastric alterations were dismal; only in the case of fundic parietal cells were both treatments able to compensate for the hypertrophic effect caused by asthma, while in the pylorus parietal cell asthma- induced hypertrophy was only compensated for by Modul8TM.

La literatura científica, aunque limitada en esta área, apoya la hipótesis de que el asma, por medio del tráfico selectivo de leucocitos entre los diferentes sitios y la mucosa glandular del cuerpo, puede tener los mismos efectos fisiopatológicos en el estómago y las vías respiratorias. Este estudio tuvo como objetivo determinar si el asma, en ausencia y presencia de diversos tratamientos para el asma (hidrocortisona y Modul8 TM), generó alguna alteración morfológica en las céluals parietales y principales del estómago. El modelo murino BALB/c del ratón asmático fue el modelo de elección en este estudio. El protocolo de inducción de asma, así como el tratamiento del asma demostró ser eficaz con la ayuda de lavado bronquial y cuantificación leucocitaria del fluido. Biopsias de las regiones fúndica y pilórica fueron extraídas y evaluadas por medio de microscopía electrónica de transmisión, de barrido y de luz. Las biopsias extraídas de la región fúndica y pilórica revelaron que el asma solamente induce hipertrofia de las células parietales (aumento del tamaño de las células parietales P <0,00001 en ambas regiones del estómago) e hiperfuncionamiento de las células principales. El uso de hidrocortisona y Modul8 TM, como una terapia para corregir las alteraciones gástricas fue disimil, sólo en el caso de las células parietales fúndicas ambos tratamientos fueron capaces de compensar el efecto hipertrófico causado por el asma, mientras que en la célula parietal pílorica la hipertrofia inducida por el asma solamente se vio compensada por Modul8TM.

Hypertrophic pyloroduodenal tuberculosis

Hypertrophic pyloroduodenal tuberculosis is a rare cause of Gastric Outlet Obstruction [GOO] often forgotten in the differential diagnosis of gastric outlet obstruction. Since laboratory and radiological investigations often prove inconclusive in reaching the diagnosis of hypertrophic pyloroduodenal tuberculosis, surgery has a key role in the management of hypertrophic pyloroduodenal tuberculosis. Postoperative anti-tuberculosis chemotherapy [ATT] becomes imperative for complete resolution of hypertrophic pyloroduodenal tuberculosis. This case report describes the condition and management in a young girl

Does troncular vagotomy modify the proliferative gastric lesions induced in rats by duodenogastric reflux

PURPOSE: to investigate if combining VT to DGR through the pylorus can modulate the biological behavior of PL induced by DGR and to verify if TV alone can induce morphologic lesions in the gastric mucosa. METHODS: 62 male Wistar rats were assigned to four groups: 1 - Control (CT) gastrotomy; 2 - Troncular Vagotomy (TV) plus gastrotomy; 3 - Duodenogastric reflux through the pylorus (R) and 4 - Troncular vagotomy plus DGR (RTV). The animals were killed at the 54 week of the experiment. DGR was obtained by anastomosing a proximal jejunal loop to the anterior gastric wall. TV was performed through isolation and division of the vagal trunks. Gastrotomy consisted of 1 cm incision at the anterior gastric wall. PL were analyzed gross and histologically in the antral mucosa, at the gastrojejunal stoma and at the squamous portion of the gastric mucosa. RESULTS: Groups R and RTV developed exophytic lesions in the antral mucosa (R=90.9 percent; RTV=100 percent) and at the gastrojejunal stoma (R=54.54 percent; RTV=63.63 percent). Histologically they consisted of proliferative benign lesions, without cellular atypias, diagnosed as adenomatous hyperplasia. Both groups exposed to DGR presented squamous hyperplasia at the squamous portion of the gastric mucosa (R= 54.5 percent; RTV= 45.4 percent). TV, alone, did not induce gross or histological alterations in the gastric mucosa. TV did note change the morphologic pattern of the proliferative lesions induced by DGR. CONCLUSIONS: DGR induces the development of PL in the pyloric mucosa and at the gastrojejunal stoma. TV does not change the morphologic pattern of the proliferative lesions induced by DGR. TV alone is not able to induce morphologic lesions in the gastric mucosa.

OBJETIVO: investigar se a adição da VT ao RDG através do piloro, interfere no comportamento biológico das LP induzidas pelo RDG e observar se a VT isoladamente leva ao desenvolvimento de lesões morfológicas na mucosa gástrica. MÉTODOS: Foram utilizados 62 ratos Wistar machos, distribuídos em quatro grupos experimentais: 1- Controle (CT) Gastrotomia; 2- Vagotomia Troncular + gastrotomia (VT); 3-Refluxo duodeno-gástrico (R) e 4- RDG através do piloro e VT (RTV). Os animais foram sacrificados na 54ª semana do experimento. O RDG foi obtido através de anastomose do jejuno proximal com a parede gástrica anterior. A vagotomia troncular foi realizada através da dissecção e divisão dos troncos vagais. A gastrotomia consistiu de secção e síntese de um cm na parede gástrica anterior. As LP foram analisadas macroscopicamente e histologicamente na mucosa gástrica, na anastomose gastrojejunal e no estômago escamoso. RESULTADOS: Os grupos R e RVT desenvolveram lesões exofíticas na mucosa do antro gástrico (R=90,9 por cento e RVT=100 por cento) e na anastomose gastrojejunal (R=54,5 por cento e RVT=63,6 por cento) que se caracterizaram no exame histológico por lesões proliferativas epiteliais benignas, sem atipias celulares, diagnosticadas como hiperplasia adenomatosa. Na região do estômago escamoso, ambos os grupos expostos ao RDG apresentaram hiperplasia escamosa (R= 54,5 por cento e RVT= 45,4 por cento). A VT não modificou o padrão histopatológico das LP induzidas pelo RDG. Os grupos VT e CT não apresentaram alterações macroscópicas ou histológicas significativas. CONCLUSÕES: o RDG induz o desenvolvimento de lesões proliferativas (LP) benignas na mucosa do antro gástrico e na anastomose gastrojejunal. A VT isoladamente não induz alterações proliferativas na mucosa gástrica e não modifica as características morfológicas das LP induzidas pelo RDG através do piloro.

Pyloric wall thickening in carcinoma stomach: a pseudokidney sign on computed tomography.

Bowel wall thickening on ultrasound simulates appearance of kidney. The appearance of kidney on contrast enhanced computed tomography is entirely different. However, surprisingly bowel wall thickening or mass can mimic this appearance even on contrast enhanced computed tomography. A case of pyloric malignancy with pseudokidney appearance on contrast enhanced computed tomography is being reported.

Gastric proliferative lesions induced by duodenogastric reflux in rats

OBJETIVO: Avaliar as lesões proliferativas que se desenvolvem na mucosa gástrica de ratos Wistar após modelo específico de refluxo duodeno-gástrico.MÉTODOS: Foram utilizados 75 ratos adultos machos divididos em três grupos experimentais: o grupo I (controle) submetido a gastrotomia na parede posterior do estômago glandular (25 animais); o grupo II (RDG), foi submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular (25 animais) e o grupo III (RDG-P) submetido a gastrojejunoanastomose látero-lateral na parede posterior do estômago glandular, com secção e fechamento da alça (25 animais). Os animais foram observados durante 36 semanas, após o que foram realizados estudos macroscópicos e microscópicos da anastomose gastrojejunal, da região pré-pilórica e região escamosa do estômago. RESULTADOS: Os animais do Grupo I não apresentaram nenhum tipo de lesão. No grupo II observou-se 40% de lesões do tipo hiperplasia adenomatosa na anastomose e 12% de hiperplasia escamosa. No grupo III obteve-se 40% de hiperplasia adenomatosa na mucosa pré-pilórica, 72 % de hiperplasia adenomatosa na mucosa da anastomose, 20% de hiperplasia escamosa e 12 % de adenocarcinoma. CONCLUSÕES: O refluxo duodeno-gástrico induz a alta freqüência de lesões proliferativas na mucosa adjacente à anastomose gastrojejunal ou na mucosa pré-pilórica e o adenocarcinoma é um evento raro neste modelo experimental.

Estenose hipertrófica do piloro: caracterização clínica, radiológica e ecográfica / Hypertrophic pyloric stenosis: clinical, radiographic and sonographic characterization

Estenose hipertrófica do piloro é uma condição comum em infantes com 2 - 12 semanas de idade e cuja causa permanece desconhecida. O diagnóstico clínico baseia-se na história de vômitos não-biliosos em jato, sinais de hiperperistalse gástrica e "tumor" pilórico palpável ao exame físico. Os autores ilustram os típicos achados desta alteração em seriografias do trato gastrointestinal superior e na ultra-sonografia abdominal. Critérios diagnósticos são descritos e as aplicações desses dois métodos são estabelecidos segundo a literatura vigente

Hypertrophic pyloric stenosis is a common condition in infants with 2 - 12 weeks of postnatal life. The cause of this disease remains obscure. Clinical diagnosis is based on the history of projectile, nonbilious vomiting, gastric hyperperistalsis and a palpable pyloric "tumor". The authors review the typical findings seen on upper gastrointestinal x-ray series and abdominal ultrasonography. The diagnostic criteria for hypertrophic pyloric stenosis are presented and the applications of these two methods are established on the basis of the current literature.

Double pylorus

Double pylorus (DP) or duplication of the pylorus is an uncommon condition that is either congenital or acquired. Acquired double pylorus (DP) results from a peptic ulcer eroding through and creating a fistula between the duodenal bulb and the distal stomach. We report a case of an acquired double pylorus in an adult gentleman that resulted from the erosion of a duodenal and prepyloric ulcer.

Pyloric perforation in utero in association with leukemoid reaction and hydrops fetalis

A 36-weeks dysmorphic newborn baby who presented with an antenatal diagnosis of intra-abdominal "cyst" and hydrops foetalis was proven to have a large cystic peritonitis. This was secondary to a large pyloroduodenal perforation, causing hemorrhagic ascites and abdominal wall and pedal edema. The peripheral blood picture was consistent with a myeloproliferative state. It was unclear whether the large perforation was secondary to necrotizing enteropathy seen in acute leukemia

Efectos producidos por spinitectus jamundensis, nematoda cystidicolidae, en el estómago del sábalo prochilodus lineatus pisces prochilodidae / Effects produced by spinitectus jamundensis, nematoda cystidicolidae, in the stomach of the shad prochilodus lineatus pisces prochilodidae

The presence of the nematode spinitectus jamundensis in cardial and pyloric regions of the stomach of prochilodus lineatus is observed. Samples of the parasitized stomach were analyzed by histological techniques using hematoxilin eosin and mallory (azan) Heidenhainïs stainnigs. The macroscopical description of the inner surface of th stomach showing damages in the parasites penetration sites, were observed. Histological observations show that the parasite enters the mucous membrane reaching muscular mucous membrane of the cardial region or the epithelial plaits in the pyloric region reaching up to the muscular layer without crossing it. In this way, the parasite remains confined by a thin layer of connective tissue and in almost direct contact with tissue liquids. Sometimes, in host tissues as response to the parasite presence, an increased level in the amount of lymphocytes in the surrounding tissues is observed

Double pylorus: case report and review of the literature

Duplo piloro e condicao rara em que se forma dupla comunicacao entre o antro gastrico e o bulbo duodenal. Pode ser congenito ou adquirido como complicacao de doenca cloridropeptica. Apresentamos caso de duplo piloro adquirido em paciente masculino com epigastralgia e historia previa de ulcera peptica. A pesquisa do Helicobacter pylori foi positiva em amostras de tecido gastrico. Foi realizada revisao da literatura e...

Hipertrofia congenita del piloro

Esta patología bastante común de causa deconocida consiste en un engrosamiento de la región antral, lo que produce un estrechamiento del canal, y por tanto su facil obstrucción. Esto ocasiona regurgitación y/o vómitos, deposiciones escasas e infrecuentes, deshidratación, desequilibrio hidroelectrolítico, y posible perdida de peso; mediante palpación se puede detectar en un 70 por ciento de los casos una masa en epigastrio. La incidencia varía de 1:1000 a 3:1000 nacimientos, con mayor probabilidad de afectar a las mujeres que a los hombres; debiendo además considerarse la incidencia familiar y la del primogénito. El diagnostico adecuado es clínico, y se obtiene por la anamnesis y el examen físico en el que se detecta la presencia de tumoración, al igual que mediante el ultrasonido y la serie gastroduodenal, a pesar de que algunos autores sugieren que éstas dos últimas técnicas ayudan al diagnostico por imágenes, en cambio han restado importancia al diagnóstico clínico. Aunque la endoscopia flexible del tracto digestivo es sencilla y afectiva, no es muy utilizada. El tratamiento clínico está encaminado a recuperar al paciente de su deshidratación y desequilibrio hidroelectrolítico. El tratamiento indicado y de elección es el quirurgico. Realizándose la piloromiotomía der Fredet-Ramstedt. Con el diagnostico precoz, la preparación pre-operatoria adecuada y el procedimiento quirurgico acertado se tiene una mortalidad del 0 por ciento.

Estenosis pilórica en niños en el Hospital "Dr. Patrocinio Peñuela Ruíz" IVSS / Pyloric stenosis in children in the Hospital \"Dr. Patrocinio Peñuela Ruiz\" IVSS

La estenosis hipertrófica congénita del píloro (EHCP), ocurre clasicamente en el transcurso de las primeras cinco semanas después de el nacimiento. De manera típica los niños afectados presentan vómitos no biliosos, alcalosis metabólica y deshidratación debido a la obstrucción gástrica (1). Además del daño anatómico existente también se ha sugerido la falta de la enzima oxidonitrico-sintetaza en el tejido pilórico, como responsable de el píloro espasmo en los niños con EHCP (2) La identificación de un agrandamiento pilórico (oliva pilórico) por palpación, ultrasonografía o radiología. Es patognomonico de esta entidad, la cual es resuelta efectivamente mediante la piloromiotomía (1). El interés de este estudio retrospectivo, es determinar la experiencia de la EHCP en el Hospital Patrocinio Peñuela Ruíz, IVSS, San Cristóbal, Edo. Táchira, Venezuela, entre los años 1983-1992

Diagnóstico sonográfico de la estenosis hipertrófica del píloro / The sonographic diagnosis of hypertrophic stenosis of the pylorus

The clinical records of 18 children were studied, between 15 and 60 days old. They were hospitalized due to vomiting and diagnosis of suspected pyloric hypertrophic stenosis (PHS). The sonography confirmed the diagnosis in 8 children, by the thickening of the muscular layer and enlargement of the pyloric canal. The surgery (pyloromyotomy) ratified the diagnosis in all 8 children. They all were in good health after being operated