Estenosis hipertrófica del píloro en la Orinoquía colombiana (2010-2020)

Introducción: La hipertrofia del esfínter pilórico (EHP) es una condición que se caracteriza por la obstrucción del vaciamiento gástrico fisiológico y se considera una patología de resolución quirúrgica. Objetivo: Realizar la caracterización de los pacientes con hipertrofia congenita del píloro atendidos en el Hospital Regional de la Orinoquía entre 2010 y 2020. Metodología: Estudio observacional, descriptivo y retrospectivo en el cual se incluyeron los pacientes que consultaron al Hospital Regional de la Orinoquía entre el 01 de enero del 2010 y el 31 de diciembre del 2020 y que presentaron diagnóstico de hipertrofia congenita del píloro, identificados mediante los códigos CIE 10. Resultados: En total, se incluyeron 18 pacientes que cumplían con los criterios de selección. El promedio de edad de los participantes fue de 24,3 días de edad. La mayoría eran varones, asimismo, dos pacientes presentaban sobrepeso al nacer. El síntoma predominante fue la emesis posprandial en un 100 %. El diagnóstico se realizó mediante las medidas del píloro con ecografía abdominal y a la totalidad de los pacientes se les realizó piloromiotomía, de los cuales uno solo requirió una reintervención, sin embargo, ningún paciente falleció. Conclusiones: La hipertrofia congenita del píloro es una entidad patológica poco común, su síntoma clínico cardinal es la emesis postprandial. El método diagnóstico por excelencia es el estudio ecográfico. A pesar de su complejidad, esta entidad patológica tiene un buen pronóstico a corto y largo plazo.

Introduction: Hypertrophic pyloric stenosis (HPS) is a condition that is characterized by the obstruction of physiological gastric emptying and is considered a surgically-resolved pathology. Objective: To characterize patients with congenital hypertrophy of the pylorus treated at the Regional Hospital of Orinoquía between 2010 and 2020. Methods: Observational, descriptive and retrospective study of patients who were admitted at the Orinoquía Regional Hospital between January of 2010 and December of 2020. The patients that were included had a diagnosis of hypertrophic pyloric stenosis identified by the ICD-10 codes. Results: A total of patients were included by selection criteria. The average age of participants was 24.3 days old. Most of them were males and 2 patients were overweight at birth. The most common symptom was postprandial emesis in 100%. The diagnosis was made through measurements of pylorus measured with abdominal ultrasound. All the patients performed pyloromyotomy, and only one required a surgical reintervention, however, the mortality was 0. Conclusions: Congenital hypertrophy of pylorus is an uncommon pathology, whose cardinal symptom is postprandial emesis. The ideal diagnostic method is an ultrasound study. Despite its complexity, this pathology has a good short and long-term prognosis.

Diagnóstico imagenológico de estenosis hipertrófica del píloro en 119 pacientes durante quince años / Imaging diagnosis of hypertrophic pyloric stenosis in 119 patients during fifteen years / Diagnóstico por imagem de estenose de pilópio hipertrófico em 119 pacientes ao longo de quinze anos

RESUMEN La estenosis hipertrófica del píloro es la obstrucción parcial o completa de la luz del píloro, su musculatura se halla tan fuertemente engrosada, que el vaciamiento gástrico se dificulta. Aunque el diagnóstico es básicamente clínico, los estudios imagenológicos son decisivos para confirmar la enfermedad. Se realizó un estudio descriptivo retrospectivo en 119 pacientes con manifestaciones clínicas de estenosis hipertrófica del píloro, cuyo diagnóstico se confirmó mediante estudios de imágenes, en el Hospital Pediátrico Universitario "William Soler" desde el año 2000 al 2015. Las medidas ecográficas fueron la longitud del canal pilórico ≥ 16mm en 95,8%, la pared del músculo pilórico en 88,2% y el diámetro de la oliva pilórica en el 68,1 % de los pacientes. En 90 niños se hizo el diagnóstico con la ecografía de abdomen inicial. A los 29 restantes se les realizó radiografía de esófago, estómago y duodeno bajo visión fluoroscópica, observando en el 100% el signo de la cuerda, en 72,4% dilatación gástrica y en 58,6% retardo en la evacuación del estómago. Con una segunda ecografía de abdomen positiva. Corroborándose en todos el diagnóstico en el acto quirúrgico. La ecografía de abdomen fue un medio diagnóstico de alta positividad y sensibilidad, con la longitud del canal pilórico como principal medida ecográfica y el signo de la cuerda el mayor hallazgo radiológico.

ABSTRACT Hypertrophic stenosis of the pylorus is the partial or complete obstruction of the pylorus lumen, its muscles are so strongly thickened that gastric emptying is difficult. Although the diagnosis is basically clinical, imaging studies are decisive to confirm the disease. A retrospective descriptive study was carried out in 119 patients with clinical manifestations of hypertrophic pyloric stenosis, whose diagnosis was confirmed by imaging studies, at the "William Soler" University Pediatric Hospital from 2000 to 2015. The ultrasound measurements were the length of the pyloric channel ≥ 16mm in 95.8%, the wall of the pyloric muscle in 88.2% and pyloric olive diameter in 68.1% of the patients. In 90 children, the diagnosis was done by initial abdominal sonography. The remaining 29 were done barium upper gastrointestinal studies under fluoroscopic vision, observing the string sign in 100%, gastric dilatation in 72.4% and delayed gastric emptying in 58.6%. With a second positive abdominal sonography. Corroborating the diagnosis in the surgical act. Abdominal sonography was a highly positive and sensitive diagnostic study, with the length of the pyloric canal as the main ultrasound measurement and the string sign the major radiological finding.

RESUMO Estenose de pilão hipertrófico é a obstrução parcial ou completa do lúmen do pilão, sua musculatura é tão fortemente espessada, que o esvaziamento gástrico é difícil. Embora o diagnóstico seja basicamente clínico, os estudos de imagemsão decisivos na confirmação da doença. Um estudo retrospectivo descritivo foi realizado em 119 pacientes com manifestações clínicas de estenose de pilópio hipertrófico, cujo diagnóstico foi confirmado por estudos de imagem, no Hospital Pediátrico da Universidade William Soler de 2000 a 2015.As medidas de ultrassom foram o comprimento do canal pilórico ≥ 16mm em 95,8%, a parede do músculo pilórico em 88,2% e o diâmetro da azeitona pilórica em 68,1% dos pacientes. Em 90 crianças, o diagnóstico foi feito com o ultrassom abdominal inicial. Os 29 restantes foram raio-x do esôfago, estômago e duodeno sobvisão fluoroscópica, observando 100% o sinal da corda, 72,4% de dilatação gástrica e 58,6% de atraso na evacuação do estômago. Com um segundo ultrassom abdominal positivo. Corroborando todo o diagnóstico no ato cirúrgico. O ultrassom do abdômen foi um meio diagnóstico de alta positividade e sensibilidade, com o comprimento do canal pilóico como principal medida de ultrassom e o sinal da corda o maior achado radiológico.

Características clínicas y epidemiológicas de la estenosis hipertrófica del píloro en un hospital de Lima, Perú / Clinical and epidemiological characteristics of hypertrophic pyloric stenosis in a hospital in Lima, Perú

RESUMEN Objetivo: Determinar las características clínicas y epidemiológicas de la estenosis hipertrófica de píloro en un hospital de Lima, Perú. Materiales y métodos: Se realizó un estudio descriptivo, retrospectivo correspondiente a los años 2013 al 2019, en el servicio de Cirugía Pediátrica del Hospital Docente Madre Niño "San Bartolomé". Se recolectaron datos de las historias clínicas con diagnóstico de estenosis hipertrófica de píloro. Resultados: Participaron un total de 59 pacientes, de los cuales 79,7 % fueron varones, 68,4 % primogénitos, con una media de edad de 31.3 +/- 13.6 días de nacido. 100 % presentó vómitos, 44,1 % reptación abdominal y solo 35,6 % presentó oliva pilórica palpable. Tiempo quirúrgico promedio 51.39 minutos, estancia hospitalaria promedio de 6.35, se presentó complicaciones mayores en un 13,6 %, con una mortalidad de 3,4 %. Conclusiones: Es importante el inicio precoz de la vía oral, así como el manejo postquirúrgico en estos pacientes para disminuir su estancia hospitalaria y el desarrollo de complicaciones ventilatorias posquirúrgicas.

ABSTRACT Objective: To determine clinical and epidemiological characteristics of hypertrophic pyloric stenosis in a hospital in Lima, Peru. Materials and Methods: A descriptive and retrospective study encompassing years 2013 to 2019 was performed in the Pediatric Surgery Service of San Bartolome Teaching Mother and Child Hospital. Data from clinical records of patients diagnosed with hypertrophic pyloric stenosis was collected. Results: Records from fifty-nine patients were obtained, 79% were male, 68.4% were first born, and their mean age was 31.3 ± 13.6 days. All patients (100 %) had vomit, 44.1% had abnormal abdominal movement, and only 35.6% had palpable pyloric olive. The average surgical correction time was 51.39 minutes, and the average hospital stay was 6.35 days, major complications occurred in 13.6% of all children, and the mortality rate was 3.4%. Conclusions: Early initiation of oral intake is important, as well as post-surgical management in these patients, in order to reduce their in-hospital stay and the development of post-surgical ventilatory complications.

Gastric twist after sleeve gastrectomy: a proposal for endoscopic classification / Torção gástrica após gastrectomia vertical: uma proposta de classificação endoscópica

ABSTRACT - BACKGROUND: The twisting of the gastric tube is one of the main causes of persistent reflux and food intolerance after sleeve gastrectomy (SG). To date, there is no classification for gastric twist after SG. OBJECTIVE: This study aimed to propose an endoscopic classification for this condition and outline the clinical profile of these patients with sleeve gastrectomy. METHODS: Patients in the postoperative period of SG presenting endoscopic findings of gastric twist were included. All patients underwent an esophagogastroduodenoscopy 12 months after SG. The classification proposed consists of three degrees: degree I: mild rotation of the staple line without relevant shrinkage of the gastric lumen; degree II: moderate rotation of the staple line, leading to a focal area of fixed narrowing that requires additional maneuvers for its transposition; and degree III: severe rotation of the staple line leading to stenosis, with increased difficulty for transposition or complete blockage. RESULTS: Out of 2,723 patients who underwent SG, 45 (1.6%) presented gastric twist. Most patients were female (85%), with mean age of 39±10.4 years. In all, 41 (91.1%) presented degree I, 3 (6.7%) presented degree II, and 1 (2.2%) had degree III. Most patients were asymptomatic (n=26). Vomiting was the most prevalent symptom (15.5%). Statistically significant correlation of twisting degrees was not observed for both the presence of symptoms and the degrees of esophagitis. CONCLUSION: Gastric twist after SG is rare, with generally mild and asymptomatic presentation. The endoscopic classification was not statistically related to clinical presentation but set the ground for further analysis.

RESUMO - RACIONAL: A torção do tubo gástrico ou twist é uma das principais causas de refluxo persistente e intolerância alimentar após a gastrectomia vertical (GV). Até o momento, não há uma classificação proposta para a torção gástrica após GV. OBJETIVO: Propor uma classificação endoscópica para essa condição e descrever o perfil clínico desses pacientes. MÉTODOS: Pacientes no pós-operatório de GV apresentando achados endoscópicos de twist foram incluídos. Os pacientes foram submetidos a uma esofagogastroduodenoscopia 12 meses após a cirurgia. A classificação consiste em três graus. Grau I: rotação leve da linha de grampos, sem redução relevante do lúmen gástrico. Grau II: rotação moderada da linha de grampos, levando a uma área de estreitamento focal que requer manobras adicionais para a progressão do aparelho. Grau III: rotação severa da linha de grampos, levando à estenose, com grande dificuldade de progressão ou obstrução completa. RESULTADOS: Dos 2.723 pacientes que foram submetidos à GV, 45 (1,6%) apresentaram twist. A maioria dos pacientes era do sex feminino (85%), com idade média de 39±10.4 anos. Quarenta e um (91,1%) apresentaram twist grau I, 3 (6,7%) apresentaram twist grau II e apenas 1 (2,2%) apresentou twist grau III. A maioria dos pacientes eram assintomáticos (n=26). O sintoma mais prevalente foi vômito (15,5%). Não foi observada correlação estatisticamente significante entre o grau de twist e a presença de sintomas ou esofagite. CONCLUSÃO: Twist após GV é raro e geralmente assintomático. A classificação endoscópica proposta não foi estatisticamente relacionada com apresentação clínica, porém estabelece um referencial para análises futuras.

[Endoscopic treatment of cicatricial pyloric stenosis of peptic origin in a 4-year-old boy]. / Tratamiento endoscópico de la obstrucción del tracto de salida gástrico de origen péptico-cicatricial en un niño de 4 años.

Gastric outlet obstruction is an uncommon condition in children. Traditionally, surgery has been the standard mode of treatment, but it is associated with higher morbidity and mortality. Endoscopic treatment has emerged as an alternative to conventional treatment. We present the case of a 4-year-old patient with refractory prepyloric stenosis secondary to peptic ulcer disease. The picture begins with vomiting and abdominal pain of 2 months of evolution. Pre-pyloric stenosis was confirmed. Faced with the lack of response to medical treatment and balloon dilation, radiated incisions were made with electrocautery and steroid injections. When medical treatment is not sufficient, endoscopic balloon therapy should be the first therapeutic gesture in this type of stenosis; given its refractoriness, we believe it is important to highlight the usefulness of endoscopic treatment, which could prevent surgery and associated morbidity and mortality.

La obstrucción de la salida gástrica es una afección infrecuente en la edad pediátrica. Tradicionalmente, la cirugía ha sido el modo de tratamiento estándar, pero está asociada a mayor morbimortalidad. El tratamiento endoscópico ha surgido como una alternativa al tratamiento convencional. Presentamos el caso de un paciente de 4 años con estenosis prepilórica secundaria a enfermedad ulceropéptica. El cuadro clínico empezó con vómitos y dolor abdominal de 2 meses de evolución. Frente a la falta de respuesta al tratamiento médico y a la dilatación endoscópica con balón, se realizaron incisiones radiadas con electrocauterio e inyecciones de esteroides. La terapéutica endoscópica con balón debería ser el primer gesto terapéutico en este tipo de estenosis refractarias al tratamiento médico.

Características clínico-epidemiológicas en pacientes con estenosis hipertrófica del píloro. Estudio de 15 años en un centro terciario / Clinic-epidemiological characteristics in patients with hypertrophic pyloricstenosis. 15-year study in a tertiary center / Características clínico-epidemiológicas em pacientes com estenose hipertrófica do piloro. Estudo de 15 anos em um centro terciário

RESUMEN La estenosis hipertrófica del píloro está caracterizada por una hipertrofia e hiperplasia de las fibras musculares y estrechamiento del canal pilórico, que provoca vómitos no biliosos, dando lugar a una de las causas más comunes de tratamiento quirúrgico en la etapa de recién nacido. Se realizó un estudio descriptivo retrospectivo en 119 pacientes con el diagnóstico de estenosis hipertrófica del píloro en el Hospital Pediátrico Universitario "William Soler" desde el año 2000 al 2015. El 70,6% de los niños tenía entre tres y cinco semanas de nacido y el 83,2% un peso al diagnóstico entre 2500 g a 4500 g. El vómito estuvo presente en todos los pacientes, las alteraciones del peso corporal en 79,8% y los desequilibrios hidroelectrolíticos y acido básico en el 53,8%. El sexo masculino, apariencia racial blanca, ser primogénito y la lactancia artificial o mixta, fueron factores de riesgos prevalentes significativos asociados a la enfermedad (p<0.05). La estenosis hipertrófica del píloro se diagnosticó con mayor frecuencia a la 4ta semana de vida y en niños con un peso entre 3000 a 4500 g. Las variaciones ponderales denotan la importancia del seguimiento de la curva de peso en estos pacientes.

ABSTRACT Hypertrophic pyloric stenosis is characterized by hypertrophy and hyperplasia of the muscle fibers and narrowing of the pyloric canal, which causes non-bilious vomiting, giving rise to one of the most common causes of surgical treatment in the newborn stage. A retrospective descriptive study was carried out in 119 patients with a diagnosis of hypertrophic pyloric stenosis at the "William Soler" University Pediatric Hospital from 2000 to 2015. 70.6% of the children were between three and five weeks old and 83.2% a weight at diagnosis between 2500 g to 4500 g. Vomiting was present in all patients, alterations in body weight in 79.8% and hydroelectrolyte and basic acid imbalances in 53.8%. Male sex, white racial appearance, being first-born, and artificial or mixed breastfeeding were significant prevalent risk factors associated with the disease (p <0.05). Hypertrophic pyloric stenosis was most frequently diagnosed at the 4th week of life and in children weighing between 3000 and 4500 g. The weight variations denote the importance of following the weight curve in these patients.

RESUMO A estenose hipertrófica do piloro é caracterizada por hipertrofia e hiperplasia das fibras musculares e estreitamento do canal pilórico, que causa vômitos não biliosos, sendo uma das causas mais comuns de tratamento cirúrgico na fase neonatal. Um estudo descritivo retrospectivo foi realizado em 119 pacientes com diagnóstico de estenose pilórica hipertrófica no Hospital Pediátrico da Universidade "William Soler" de 2000 a 2015. 70,6% das crianças tinham entre três e cinco semanas de idade e 83,2% com peso ao diagnóstico entre 2500 ga 4500 g. Vômito esteve presente em todos os pacientes, alteração do peso corporal em 79,8% e desequilíbrio hidroeletrolítico e ácido básico em 53,8%. Sexo masculino, raça branca, primogênito e amamentação artificial ou mista foram fatores de risco prevalentes e significativos associados à doença (p <0,05). A estenose hipertrófica do piloro foi diagnosticada com maior frequência na 4ª semana de vida e em crianças com peso entre 3.000 e 4.500 g. As variações de peso denotam a importância de seguir a curva de peso nesses pacientes.

Guía de Práctica Clínica de estenosis hipertrófica del píloro / Clinical Practice Guidelines in Hypertrophic Pyloric Stenosis

La estenosis hipertrófica del píloro es una enfermedad que se presenta fundamentalmente en lactantes, ocurre por un estrechamiento del canal pilórico debido a la hipertrofia gradual de la capa muscular de su esfínter, lo que origina un síndrome pilórico. El objetivo de esta publicación es presentar una actualización sobre el tema. La etiología de la enfermedad es desconocida, la tendencia actual es que se trata de una enfermedad que no es congénita y se sugiere un origen multifactorial, donde influyen factores genéticos y ambientales. Su síntoma fundamental son los vómitos no biliosos y el diagnostico se complementa con el ultrasonido abdominal. El tratamiento de elección es quirúrgico y sus resultados generalmente satisfactorios. La aprobación de esta guía por los servicios de cirugía pediátrica del país la convierten en un útil instrumento asistencial y docente(AU)

Hypertrophic Pyloric Stenosis is a disease that occurs mainly in infants, caused by a narrowing of the pyloric channel due to the gradual hypertrophy of the muscle layer of the sphincter, which originates a pyloric syndrome. The aim of this publication is to present an update on the topic. The etiology of the disease is unknown, the current trend is that it is a disease that is not congenital and a multifactorial origin is suggested, where genetic and environmental factors influence. Its main symptom is non-bilious vomiting and diagnosis is supplemented with abdominal ultrasound. The treatment of choice is the surgical one and its results are generally satisfactory. The approval of this guidelines by the country's pediatric surgery services makes it a useful care and teaching tool(AU)

Tratamiento endoscópico de la obstrucción del tracto de salida gástrico de origen péptico-cicatricial en un niño de 4 años / Endoscopic treatment of cicatricial pyloric stenosis of peptic origin in a 4-year-old boy

La obstrucción de la salida gástrica es una afección infrecuente en la edad pediátrica. Tradicionalmente, la cirugía ha sido el modo de tratamiento estándar, pero está asociada a mayor morbimortalidad. El tratamiento endoscópico ha surgido como una alternativa al tratamiento convencional. Presentamos el caso de un paciente de 4 años con estenosis prepilórica secundaria a enfermedad ulceropéptica. El cuadro clínico empezó con vómitos y dolor abdominal de 2 meses de evolución. Frente a la falta de respuesta al tratamiento médico y a la dilatación endoscópica con balón, se realizaron incisiones radiadas con electrocauterio e inyecciones de esteroides. La terapéutica endoscópica con balón debería ser el primer gesto terapéutico en este tipo de estenosis refractarias al tratamiento médico

Gastric outlet obstruction is an uncommon condition in children. Traditionally, surgery has been the standard mode of treatment, but it is associated with higher morbidity and mortality. Endoscopic treatment has emerged as an alternative to conventional treatment. We present the case of a 4-year-old patient with refractory prepyloric stenosis secondary to peptic ulcer disease. The picture begins with vomiting and abdominal pain of 2 months of evolution. Pre-pyloric stenosis was confirmed. Faced with the lack of response to medical treatment and balloon dilation, radiated incisions were made with electrocautery and steroid injections. When medical treatment is not sufficient, endoscopic balloon therapy should be the first therapeutic gesture in this type of stenosis; given its refractoriness, we believe it is important to highlight the usefulness of endoscopic treatment, which could prevent surgery and associated morbidity and mortality.

Experiencia con los stents metálicos autoexpandibles para el manejo de cáncer gástrico distal / Auto-expandable metal stent in the management of distal stomach cancer

Objetivos: Establecer la eficacia y seguridad de los stents metálicos antroduodenales para el tratamiento del síndrome pilórico en pacientes con cáncer gástrico distal. Materiales y métodos: Se obtuvo datos de 31 pacientes mayores de 18 años que tenían diagnóstico de cáncer gástrico distal entre el año 2009 y el año 2017, quienes presentaban síndrome pilórico asociado a estenosis antroduodenal documentada por endoscopia o radiografía de vías digestivas altas, siendo manejados con stent metálico autoexpandible antroduodenal en la unidad de gastroenterología del Hospital Universitario San Ignacio (HUSI) de Bogotá D.C, Colombia. Resultados: El principal síntoma documentado que motivó a consultar fue la presencia de vómito en el 45,1%, seguido por pérdida de peso 16,13% y hemorragia de vías digestivas altas 19,35%, realizándose el diagnóstico en el 74,19% de los casos con endoscopia de vías digestivas altas. El 96,7% de los pacientes presentaban metástasis al momento del diagnóstico de síndrome pilórico. El 100% de los pacientes tuvo éxito técnico en relación al implante del stent con posterior resolución de síntomas en el 96,77%, siendo la complicación más frecuente el desplazamiento en un 16,13%. Conclusiones: Los stents metálicos autoexpandibles para el manejo de la obstrucción al tracto de salida gástrico secundario a cáncer gástrico distal es un método seguro y eficaz como tratamiento paliativo, mejorando la morbilidad y mortalidad en comparación con el manejo quirúrgico.

Objectives: To establish the efficacy and safety of antroduodenal metal stents for the treatment of pyloric syndrome in patients with distal gastric cancer. Materials and methods: Data were obtained from 31 patients older than 18 years who had a diagnosis of distal gastric cancer between 2009 and 2017, who presented pyloric syndrome associated with antroduodenal stenosis documented by endoscopy or X-ray of upper digestive tract, being managed with an antroduodenal auto-expandable metal stent in the gastroenterology unit of the San Ignacio University Hospital (HUSI) in Bogotá DC, Colombia. Results: The main documented symptom that led to consultation was the presence of vomiting in 45.1%, followed by weight loss 16.13% and upper digestive tract bleeding 19.35%, the diagnosis being made in 74.19 % of cases with endoscopy of upper digestive tract. 96.7% of the patients presented metastases at the time of diagnosis of pyloric syndrome. 100% of patients had technical success in relation to stenting with subsequent resolution of symptoms in 96.77%, the most frequent complication being displacement in 16.13%. Conclusions: Auto-expandable metal stents for the management of gastric outlet tract obstruction secondary to distal gastric cancer is a safe and effective method as a palliative treatment, improving morbidity and mortality compared to surgical management.

Estenosis hipertrofia del Píloro: Resolución quirúrgica por laparoscopía. Reporte de un caso

La Estenosis Hipertrófica del Píloro (EHP) constituye una condición benigna, donde la porción pilórica del estómago presenta un engrosamiento anormal, condicionando una obstrucción. El manejo y resolución es quirúrgico, y consiste en la Piloromiotomía. El abordaje por Laparoscopía en EHP ha ganado adeptos desde sus inicios en la década de los 90´s y se ha convertido en el método de elección en muchas instituciones de primer mundo a nivel mundial, basado en gran parte en las ventajas de la mínima invasión: menor manipulación de los tejidos, menor dolor postoperatorio y mejoría del tiempo de egreso hospitalario. A continuación presentamos el caso de un paciente con EHP manejado por este abordaje en nuestra Institución.

The hypertrophic pyloric stenosis (HPS) is a benign condition where the pyloric portion of the stomach presents an abnormal thickening, conditioning an obstruction. Management and resolution is surgical, and consists of Pyloromyotomy. Laparoscopic approach in the HPS has gained currency since its inception in the early 90´s and has become the method of choice in many first-world institutions worldwide, based largely on the benefits of minimally invasive surgery: less tissue manipulation, less postoperative pain and less recovery time of hospital discharge. We present the case of a patient with HPS handled by this approach in our Institution.

Estenosis pilórica del adulto, a propósito del primer caso registrado en Colombia / Adult Pyloric Stenosis, Regarding the First Reported Case in Colombia

La estenosis pilórica hipertrófica primaria en adultos es una enfermedad poco frecuente, de etiología desconocida, en la cual el diagnóstico solo puede establecerse después de la exclusión de las causas más comunes de obstrucción de la salida gástrica. El abordaje terapéutico, aunque muy diverso, puede estar encaminado a la dilatación o apertura pilórica. Se presenta el caso de una paciente de 62 años de edad que ingresó al Hospital San Rafael de Tunja con síntomas de obstrucción gástrica. En esta paciente solo fue posible dar un diagnóstico correcto de estenosis pilórica hipertrófica primaria por medio de estudios imaginológicos, para ofrecer finalmente un tratamiento adecuado.

Primary pyloric stenosis in adults is a rare disease, with an unknown etiology in which the diagnosis can only be established after excluding the most common obstruction causes of gastric transit. The treatment, although very diverse, can be geared towards dilatation or pyloric opening. In this article, we present the case of a 62-year old patient who entered the Hospital San Rafael in Tunja with symptoms of gastric obstruction. In this patient, it was only possible to give a correct diagnosis of primary hypertrophic pyloric stenosis through imaging studies, in order to finally provide adequate treatment.

Ultrasound-guided paravertebral block for pyloromyotomy in 3 neonates with congenital hypertrophic pyloric stenosis / Bloqueio paravertebral guiado por ultrassom para piloromiotomia em 3 recém-nascidos com estenose hipertrófica de piloro congênita / Bloqueo paravertebral ecoguiado para la piloromiotomía en 3 neonatos con estenosis hipertrófica de píloro congénita

Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic disorders that imply a high risk of aspiration during anesthetic induction. In this way, the carrying out of a technique with general anesthesia and intravenous rapid sequence induction, preoxygenation and cricoid pressure are recommended. After the correction of systemic metabolic alkalosis and pH normalization, cerebrospinal fluid can keep a state of metabolic alkalosis. This circumstance, in addition to the residual effect of neuromuscular blocking agents, inhalant anesthetics and opioids could increase the risk of postoperative apnea after a general anesthesia.

A estenose hipertrófica do piloro é uma condição relativamente comum do trato gastrintestinal na infância, que causa um quadro de vômitos em jato e alterações metabólicas que envolvem um alto risco de aspiração durante a indução da anestesia. Assim, recomenda-se uma técnica sob anestesia geral e indução intravenosa de sequência rápida, pré-oxigenação e pressão cricoide. Após a correção da alcalose metabólica sistêmica e normalização do pH, o líquido cerebrospinal pode manter um estado de alcalose metabólica. Isso, juntamente com os efeitos residuais de agentes bloqueadores neuromusculares, anestésicos e opioides, pode aumentar o risco de apneia pós-operatória após anestesia geral.

La estenosis hipertrófica de píloro es una afección relativamente común del tracto gastrointestinal en la infancia, que conlleva un cuadro de vómitos en proyectil y alteraciones metabólicas que implican un elevado riesgo de aspiración durante la inducción anestésica. Así, se recomienda la realización de una técnica con anestesia general e inducción de secuencia rápida intravenosa, preoxigenación y presión cricoidea. Tras la corrección de la alcalosis metabólica sistémica y normalización del pH, el líquido cefalorraquídeo puede mantener un estado de alcalosis metabólica. Esta circunstancia, junto con el efecto residual de los bloqueantes neuromusculares, agentes anestésicos inhalatorios y opioides podrían incrementar el riesgo de apnea postoperatoria tras una anestesia general.

Ultrasound-guided paravertebral block for pyloromyotomy in 3 neonates with congenital hypertrophic pyloric stenosis.

BACKGROUND AND OBJECTIVES: Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic disorders that imply a high risk of aspiration during anesthetic induction. In this way, the carrying out of a technique with general anesthesia and intravenous rapid sequence induction, preoxygenation and cricoid pressure are recommended. After the correction of systemic metabolic alkalosis and pH normalization, cerebrospinal fluid can keep a state of metabolic alkalosis. This circumstance, in addition to the residual effect of neuromuscular blocking agents, inhalant anesthetics and opioids could increase the risk of postoperative apnea after a general anesthesia. CASE REPORT: We present the successful management in 3 neonates in those a pyloromyotomy was carried out because they had presented congenital hypertrophic pyloric stenosis. This procedure was done under general anesthesia with orotracheal intubation and rapid sequence induction. Then, ultrasound-guided paravertebral block was performed as analgesic method without the need for administrating opioids within intraoperative period and keeping an appropriate analgesic level. CONCLUSIONS: Local anesthesia has demonstrated to be safe and effective in pediatric practice. We consider the ultrasound-guided paravertebral block with one dose as a possible alternative for other local techniques described, avoiding the use of opioids and neuromuscular blocking agents during general anesthesia, and reducing the risk of central apnea within postoperative period.

[Ultrasound-guided paravertebral block for pyloromyotomy in 3 neonates with congenital hypertrophic pyloric stenosis]. / Bloqueio paravertebral guiado por ultrassom para piloromiotomia em 3 recém-nascidos com estenose hipertrófica de piloro congênita.

BACKGROUND AND OBJECTIVES: Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic disorders that imply a high risk of aspiration during anesthetic induction. In this way, the carrying out of a technique with general anesthesia and intravenous rapid sequence induction, preoxygenation and cricoid pressure are recommended. After the correction of systemic metabolic alkalosis and pH normalization, cerebrospinal fluid can keep a state of metabolic alkalosis. This circumstance, in addition to the residual effect of neuromuscular blocking agents, inhalant anesthetics and opioids could increase the risk of postoperative apnea after a general anesthesia. CASE REPORT: We present the successful management in 3 neonates in those a pyloromyotomy was carried out because they had presented congenital hypertrophic pyloric stenosis. This procedure was done under general anesthesia with orotracheal intubation and rapid sequence induction. Then, ultrasound-guided paravertebral block was performed as analgesic method without the need for administrating opioids within intraoperative period and keeping an appropriate analgesic level. CONCLUSIONS: Local anesthesia has demonstrated to be safe and effective in pediatric practice. We consider the ultrasound-guided paravertebral block with one dose as a possible alternative for other local techniques described, avoiding the use of opioids and neuromuscular blocking agents during general anesthesia, and reducing the risk of central apnea within postoperative period.

Gastropatia pilórica hipertrófica crônica secundária à gastrite linfoplasmocitária em cão: relato de caso / Chronic hypertrophic pyloric gastropathy secundary to lymphoplasmacytic gastritis in a dog: case report / Gastropatía pilórica hipertrófica crónica secundaria a gastritis linfoplasmocitária en un perro: reporte de caso

A gastropatia hipertrófica pilórica crônica é o termo que se refere à hipertrofia pilórica sem especificar se a camada mucosa e/ou muscular estão envolvidas. O presente trabalho relata um caso de gastropatia hipertrófica crônica secundária à gastrite linfoplasmocitária em um cão. O diagnóstico foi confirmado através de celiotomia exploratória e análise histopatológica e o tratamento instituído através de piloroplastia, bem como terapia imunosupressora foram fundamentais para a melhora clínica significativa do paciente.

The gastropathy chronic hypertrophic pyloric is a term that refers to hypertrophic pyloric without specifying the mucous layer and / or muscle are involved. This paper reports a case of hypertrophic gastropathy secondary to chronic lymphoplasmacytic gastritis in a dog. The diagnosis was confirmed by exploratory laparotomy and histopathological analysis and the treatment by pyloroplasty, as well as immunosuppressive therapy have been fundamental to the clinical improvement of the patient.

La gastropatía hipertrófica del píloro crónica es un término que se refiere a hipertrofia pilórica sin especificar la capa mucosa y / o músculos que esten involucrados. Se presenta el caso de gastropatía hipertrófica secundaria a gastritis crónica linfoplasmacítica en un perro. El diagnóstico fue confirmado por el análisis exploratorio de laparotomía y histopatológico y el tratamiento por piloroplastia, así como la terapia inmunosupresora han sido fundamental para la mejoría clínica del paciente.

Estenosis hipertrófica pilórica infantil / Hypertrophic pyloric stenosis child

La estenosis hipertrófica infantil representa la condición más común que requiere resolución quirúrgica en la infancia temprana. La función y motilidad del píloro está guiada por distintos sistemas que involucran sistema nervioso entérico, hormonas gastrointestinales y las células intersticiales de Cajal, es así como distintos factores que afecten dichos componentes se ven involucrados en las distintas hipótesis de la fisiopatogenia de la enfermedad. El diagnóstico se basa clásicamente en historia clínica, examen físico y estudios de imágenes. El manejo ha sido clásicamente quirúrgico, mediante la piloromiotomía de Ramstedt, sin embargo se ha planteado manejo farmacológico mediante sulfato de atropina.

Infantile hypertrophic stenosis is the most common condition requiring surgical intervention in early childhood. The function and motility of the pylorus is guided by different systems involving enteric nervous system, gastrointestinal hormones and the interstitial cells of Cajal, is how different factors affecting these components are involved in the different hypotheses of pathogenesis of the disease. The diagnosis is typically based on clinical history, physical examination and imaging studies. The surgical management has been classically by Ramstedt pyloromyotomy, however pharmacological management has been raised by atropine sulfate.

Síndrome de estenose pilórica por adenocarcinoma de piloro / Pyloric stenosis due to adenocarcinoma of the pylorus

We present a case of primary malignant pylorus neoplasia, emphasizing its rarity, the difficulty of diagnosis and the importance of an adequate prepare before the endoscopic procedure. Literature shows that tumors compromising the first, third and fourth segments of duodenum are rare, especially those of the pyloric area, representing only 0.35% of all malignant tumors of the gastrointestinal tract. Adenocarcinoma is the most common histological type, representing 50% of all malignant neoplasias at this site. The most common symptoms are weight loss, nausea, vomiting, abdominal pain, abdominal mass, sudden changes in intestinal habits and iron deficiency anemia secondary to chronic intestinal hemorrhage. Survival after five years is only 18%. We report a case of a seventy-one year-old male referring early satiety, epigastric pain, retrosternal burning and dyspepsia, with unspecific results in complementary exams, since complete gastric emptying was not achieved. As symptoms worsened, the patient was submitted to laparotomy, with identification of gastric dilation and severe pyloric stenosis, macroscopically suggesting malignancy. The chosen procedure was a subtotal gastrectomy. Adjuvant radiotherapy and chemotherapy were not used. The patient is been followed-up without tumor recurrence so far.

Estenosis hipertrofia del píloro: Mitos y verdades

Introducción: La estenosis hipertrofia de piloro es una patología frecuente en edades tempranas. Afecta recién nacidos y lactantes pequeños . Algunos factores de riesgo son sexo masculino, grupo sanguíneos O positivo, uso de macrólidos en embarazo. El diagnóstico se realiza con una adecuada historia clínica y exploración física. Se describen síntomas como vómitos persistentes , pérdida de peso, deshidratación. El diagnóstico se confirma mediante ultrasonografía. El tratamiento en su gran mayoría es quirúrgico, siendo el pronóstico satisfactorio. Objetivo: Describir las principales características epidemiológicas , clínicas , laboratorio, diagnóstico y tratamiento y posibles complicaciones de estos pacientes. Materiales y método: Estudio retrospectivo que incluyó todos los pacientes egresados con diagnóstico de estenosis hipertrófica de píloro, desde el periodo 2005 al 30 de junio 2010 atendidos en el Hospital del Niño. Se recogieron datos mediante formulario de informe prediseñado. Resultados: Se incluyeron 53 pacientes con una media de edad de 5.2 semanas. Se encontraron en su mayoría pacientes de sexo masculino. Las principales manifestaciones clínicas fueron vómitos, disminución de peso, deshidratación. El examen diagnóstico de elección fue el ultrasonido. Todos los pacientes fueron manejado de forma quirúrgica . No se reportaron complicaciones en los pacientes. Discusión: Es una de las principales causas de cirugía en niños pequeños. El avance en el conocimiento de las manifestaciones clínicas llevan a un diagnóstico eficaz y temprano. La historia clínica y la exploración física son la herramienta principal en el diagnóstico ayudado con herramientas tecnológicas como la ultrasonografía por su alta sensibilidad, especificidad y bajo costo. El tratamiento quirúrgico es curativo con complicaciones infrecuentes y buen pronóstico a largo plazo.

Introduction: Hypertrophic pyloric stenosis is a common disease at early ages. It affects newborns and infants. Some risk factors are male sex, blood group O positive, macrolide use in pregnancy. The diagnosis is made with appropriate history and physical examination. We describe symptoms such as vomiting, weight loss dehydration. The diagnosis is confirmed by ultrasonography. Treatment is mostly surgical prognosis remains unsatisfactory. Objetive: To describe the main epidemiological , clinical , laboratory, diagnostic, treatment and possible complications in these patients. Materials and methods: Retrospective study included all patients discharged with the diagnosis of hypertrophic pyloric stenosis, from the period 2005 to June 30, 2010 treated at the Hospital del Niño. Data were collected using pre-designed report form. Results: 53 patients with a mean age of 5.2 weeks. Found mostly male patients. The main clinical manifestations were vomiting, weight loss, dehydration. The diagnostic test of choice was the ultrasound. All patients were managed surgically. There were no complications in patients. Discussion: It is a major cause of surgery in young children. The progress of knowledge in understanding the clinical findings lead to effective early diagnosis. The clinical history and physical examination is the main tool n the diagnosis helped with technological tools such as ultrasound for high sensitivity, specificity and low cost. Surgical treatment is curative with rare complications and good long-term prognosis.