Píloro doble. Presentación de un caso y revisión de la literatura / Double pylorus. Case report and literature review

RESUMEN El doble píloro es una comunicación anormal entre el antro gástrico y el bulbo duodenal y representa un raro hallazgo endoscópico. Se presentó un paciente de 80 años de edad, con antecedentes de hipertensión arterial, fumador inveterado, tomador de aspirina, que presentó melena aproximadamente 15 días antes del ingreso. La videoendoscopia reveló la existencia de dos orificios similares en el antro, que se comunicaban con el bulbo duodenal de manera independiente que fueron catalogados como píloros. La comunicación se constató con el paso del endoscopio a su través. Se impuso tratamiento médico con inhibidores de la bomba de protones y la evolución fue favorable. Es el cuarto caso reportado en la literatura en nuestro país y el primero en la provincia de Matanzas.

ABSTRACT Double pylorus is an abnormal communication between the gastric antrum and the duodenal bulb and represents a rare endoscopic finding. It is presented the case of a patient aged 80 years, with a background of arterial hypertension, inveterate smoker, taking aspirin, who presented melena about 15 days before the admission. The video-endoscopy revealed the existence of two similar orifices in the antrum that were independently communicating with the duodenal bulb and they went catalogued like pylori. The communication was proved by passing the endoscope through it. He was treated with IBP (the Spanish acronym for proton bomb inhibitors) and the evolution was favorable. It is the fourth case reported in the literature in Cuba and the first one in Matanzas.

Piloro duplo congênito / Congenital double pylorus

O piloro duplo é, em geral, um achado de exame, e não é usual a dupla comunicação do antro gástrico com o bulbo duodenal. No presente caso, o paciente apresentava uma história de epigastralgia de 30 dias e foi submetido à endoscopia digestiva com diagnóstico de gastropatia de antro. Durante o exame foi detectado piloro duplo sem sinal inflamatório ou cicatriz de úlcera, sendo aventada a possibilidade de tratar-se de piloro duplo congênito.

Syndromic association of pyloric atresia and Epidermolysis bullosa (Carmi syndrome) - a case report / Asociación sindrómica de la atresia pilórica y la Epidermolisis bullosa (síndrome de Carmi) - un reporte de caso

Epidermolysis bullosa (EB) is an inherited, autosomal recessive, bullous disease, characterized by blisters followed with skin and mucosal erosions. We present a case of a male infant with pyloric atresia associated with junctional EB (Carmi syndrome). The patient underwent urgent laparotomy after prompt stabilization. Postoperative course was uneventful. Nine months later, the patient died in the paediatric intensive care unit from respiratory distress syndrome. Prognosis is usually very poor. Death usually occurs during the first year of life, as a result of septic complications.

La epidermólisis bullosa (EB) es una enfermedad hereditaria, autosómica recesiva, y bullar, caracterizada por ampollas acompañadas de erosiones de las mucosas y la piel. Presentamos el caso de un niño con atresia pilórica asociada con EB juntural (síndrome de Carmi). El paciente fue sometido a laparotomía urgente después de una rápida estabilización. Curso postoperatorio transcurrió sin incidentes. Nueve meses más tarde, el paciente murió en la unidad de cuidados intensivos pediátricos de síndrome de dificultad respiratoria (SDR). El pronóstico es generalmente muy pobre. La muerte ocurre generalmente durante el primer año de vida, como consecuencia de las complicaciones sépticas.

validity of ultrasound in diagnosing hypertrophic pyloric stenosis

To evaluate the validity of ultrasound for diagnosis and exclusion of pyloric stenosis in the infants with nonbilious vomiting. In a cross-sectional study, 444 consecutive infants with clinical suspicion of pyloric stenosis were evaluated by ultrasound [US] and categorized as pyloric stenosis or not according measuring parameters as muscle thickness, muscle width and canal length of pylorus. Positive findings were confirmed at surgery; Negative findings were confirmed by means of follow up. Sensitivity, specificity and accuracy were calculated. Sensitivity, specificity and accuracy of ultrasound were 100% if pyloric muscle thickness of >3mm was chosen as diagnostic. When muscle thickness more than 4mm was used, sensitivity, specificity and accuracy were 96%, 100% and 99.32% respectively. Ultrasound is highly sensitive and specific if pyloric muscle thickness 3 mm is used as cut off point. By virtue of direct visualization of the pyloric muscle, ultrasound is method of choice for both the diagnosis and exclusion of pyloric stenosis in infants

Sonographic diagnosis of infantile hypertrophic pyloric stenosis- use of simultaneous grey-scale and colour doppler examination

To evaluate the accuracy of Ultrasound in the diagnosis of Infantile Hypertrophic Pyloric stenosis, especially with simultaneous use of grey-scale and colour Doppler examination of pylorus. Fifty two infants with suspected Infantile Hypertrophic Pyloric stenosis [IHPS] were evaluated with grey-scale and colour Doppler examination. The sonographic findings were categorized as positive IHPS, negative IHPS and equivocal cases. Positive sonographic findings in 21 infants [40%] were confirmed at surgery. Negative sonographic findings in 27 infants [52%] were followed by ward chart reviews. Sensitivity, Sepcificity and Accuracy of grey-scale and colour Doppler examination for the diagnosis of IHPS were 1005. Sonography is the method of choice for the diagnosis of IHPS. Simultaneous grey-scale and colour Doppler examination of pylorus for suspected IHPS is more accurate than simple grey-scale sonography

Epidermolysis bullosa simplex (Dowling-Meara type) associated with pyloric atresia and congenital urologic abnormalities

We report a case of epidermolysis bullosa simplex, Dowling-Meara type (EBS-DM), which was associated with congenital pyloric atresia (PA) and various urologic abnormalities, a diagnosis confirmed by immunofluorescence mapping and electron microscopic findings. Immunofluorescent mapping showed the serum from a patient with bullous pemphigoid faintly binding to the floor of the blister, and monoclonal antibodies against type IV and VII collagens were also stained on the floor of the blister. Electron microscopy showed epidermolytic cleavage and prominent clumping of tonofilaments in the basal and suprabasal keratinocytes. An abdominal radiograph and barium swallow showed a complete obstruction at the pyloric channel level. The widespread bullae healed without any scar formation and the bullae formation was localized on the extremities after 3 months of age without any specific treatment. Multiple urologic abnormalities such as bilateral hydronephrosis, hydroureter and a distended bladder with trabeculation were observed at 12 months of age. Currently, with the patient at 4 years of age, bullae still appear on the hands and feet and nail shedding can be observed. The patient's father, a paternal uncle and a paternal aunt had had similar bullous eruptions in infancy, all of which had improved spontaneously by the age of one.