Isolated corrosive pyloric stenosis without oesophageal involvement: An experience of 21 years

Corrosive ingestion is common in Asia and it is a frequent cause of morbidity secondary to intense fibrotic reaction and stricture formation of the oesophagus. Isolated corrosive pyloric stenosis without oesophageal involvement is an uncommon phenomenon. All consecutive patients, with corrosive ingestion in the last two decades, were reviewed and analysed. Eleven out of 201 patients with corrosive ingestion had isolated gastric outlet obstruction. Patients' age ranged from 11 to 29 years with a male: female ratio of 1.75:1. All patients developed pyloric stenosis following ingestion of solution of acids. Barium study revealed complete/ near-complete gastric outlet obstruction in all patients. On laparotomy, there was gastric dilatation in 10 patients, who underwent posterior gastrojejunostomy, whereas the stomach was contracted in one patient, and hence anterior gastrojejunostomy was performed. Seven patients were completely relieved of their symptoms; persistent postprandial epigastric fullness and/or dyspepsia was observed in four patients whose gastrojejunostomy stoma was found adequate on barium study, suggestive of gastric motility disorder. We did not encounter gastrojejunostomy-related complication of stomal ulcer/stenosis in our patients. Isolated corrosive pyloric stenosis is not as rare as is commonly thought. Gastrojejunostomy is effective, although a fair percentage of patients appear to develop gastric motility disorder secondary to corrosive injury

Usefulness of ultrasound in the diagnosis of infantile hypertrophic pyloric stenosis [IHPS]

The aim of our study was to know the diagnostic accuracy of ultrasonography in infantile hypertrophic pyloric stenosis [IHPS]. Material and This Prospective study of patients with clinical features suggestive of IHPS was carried out from January 2002 to December 2003 [2 years duration], at paediatrics surgery unit of Lady Reading Hospital Peshawar. Patients with clinical suspicion of IHPS were admitted through casualty, OPD and also shifted from other units. After clinical diagnosis of pyloric stenosis, ultrasound scanning was performed in all cases by a single experienced sonographer. All patients underwent surgery and pyloromyotomy was performed in all patients. Patients were followed up for at least 3 months. Twenty patients with clinical suspicion of IHPS were studied. The age ranged from 19 days to 120 days with average of 49 days. Male to female ratio was 19:1. The most common presenting symptom was nonbilious vomiting [100%]. Ultrasound revealed IHPS in all twenty cases. Surgery confirmed the findings of ultrasound scanning, showing 100% sensitivity of ultrasound in diagnosing IHPS. Pyloromyotomy was performed in all cases. There was no complication observed in this study. Ultrasound scanning is a useful tool of investigation and should be done in all suspected cases of IHPS to reduce the diagnostic errors leading to mismanagement

Surgical and pathological study of infantile hypertrophic pyloric stenosis in our locality

This study has included 80 newborns and infants [62 males and 18 females] suffering from infantile hypertrophic pyloric stenosis [IHPS]. The main presentation was repeated resistant vomiting, loss of weight, constipation or epigastric distention and the age of presentation was one week to five months. Fifty-eight out of 80 infants with IHPS [45 males and 13 females] were subjected to full history, thorough clinical examination and investigation in the form of pediatric endoscopy and gastrografin. From all patients, biopsy was taken from the hypertrophic layer of the pyloric antrum. The pattern of labeling in the myenteric nerve plexus layer is normal. Histochemical study revealed a marked reduction in fibers expressing nitric oxide synthase in the hypertrophic circular muscle, however, nitric oxide synthase was present in the myenteric plexus. The results have shown that the percentage of newborn with IHPS to live birth in the studied locality was 3/1000. In this study, 90% of patients had nitric oxide synthase loss in their histochemical studies of pyloric circular muscle. The management of such patients with surgical myotomy was file best procedure, while, laparoscopic or endoscopic dilatations are sill unsatisfactory to be the procedure of choice

Changing trends in hypertrophic pyloric stenosis

A three year study on Hypertrophic Pyloric Stenosis, [HPS] was conducted at the Department of Paediatric Surgery, Nishtar Hospital, Multan. Many features of HPS in published literature were not found in our study. There was male predominance, male of female ratio was 9:1. It was seen more frequently among babies of multigravida and 90% had gestation period of more than 35 weeks. Vomiting started within first week of life in all the infants. Weight of 50% patients was within normal limits. There were no gross associated anomalies, though preoperative malrotation was found in only 7.14% patients. Moderate to severe dehydration was noticed in 21.42% and hypokalaemia in 10.7% patients. Ultrasonography was diagnostic in 29.6% cases

Estenose pilórica parcial experimental em cäes, repercussöes sobre a mucosa gástrica / Experimental partial pyloric stenosis in dogs: repercussion on gastric mucosa

O objetivo é verificar se a estenose pilórica parcial experimental teria alguma repercussäo sobre a mucosa gástrica do cujo. Observou-se que somente esta causa näo parece gerar lesöes ulceradas de mucosa ou úlceras gátricas, mesmo com estases e dilataçöes gástricas acentuadas. Outros fatores, certamente, säo necessários para que isto se concretize quando há estase gástrica

role of gastrin in infantile hypertrophic pyloric stenosis

The serum gastrin level was estimated in eighteen children with infantile hypertrophic pyloric stenosis at the time of pyloromyotomy. We also estimated the gastrin level in a control group. It was found that there was no significant difference of gastrin level between the two group. It was also found that serum gastrin in the neonatal period is higher than serum gastrin of normal adultsThe widespread use of maternal ultrasonography has resulted in an increasing number of newborns diagnosed with obstructive uropathy [O.U]. Over the past 4 years, 39 neonates had been referred for evaluation of their prenatally detected O.U. thirty-four were males. Mean time of prenatal ultrasound examination was 32 +/- 2 weeks of gestation. Postnatal evaluation consisted of ultrasonography, voiding cystourethrography, excretory urography and radionuclide renal scan to assess the differental function and document the severity of obstruction. One infant died at 2 days of age. In the remaining 38 patients, surgery was needed in 34 of them. The excellent postoperative clinical and radiological status of these patients further advocates early intervention when feasible