Píloro

A case of gastric outlet obstruction secondary to antral web in a preterm infant born at 25 weeks gestation is reported. The diagnosis was suspected on plain abdominal radiograph performed postnatally to confirm position of the umbilical catheters. On the initial radiograph (at age 1 h), a dilated stomach with a gasless abdomen was noted. A repeat chest and abdominal radiograph performed 24 h later due to increased ventilatory requirements showed persistence of this finding and upper gastrointestinal obstruction was suspected...

Congenital antral webs are a rare but relevant cause of gastric outlet obstruction in infants and children. The condition may lead to feeding refusal, vomiting, and poor growth. Due to the relative rarity of the disease, cases of congenital antral web are frequently misdiagnosed or diagnosed with significant delay as physicians favorably pursue diagnoses of pyloric stenosis and gastric ulcer disease, which are more prevalent. We report a case of an eight-month-old female who presented with persistent non-bilious emesis, feeding difficulties, and failure to thrive and was discovered to have an antral web...

Antral web is a rare cause of gastric outlet obstruction in neonate. It is a 2-4 mm thin mucous membrane that can be found anywhere from 1 to 7 cm proximal to the pylorus. The baby was born at gestational age of 32(+1) weeks with 1,880 g as 2nd baby of dizygotic twin. After birth, the baby had constant non-bilious vomiting without feeding while he didn't show abdominal distension or discoloration. The infantogram showed distended stomach with distal small bowel gas. Upper gastrointestinal series revealed that the antrum was abruptly narrowed at 1 cm proximal to pylorus...

Congenital diaphragmatic hernia (CDH) is associated with multiple congenital anomalies affecting several organ systems, including the gastrointestinal system. Pyloric stenosis and bands are known and previously reported etiologies of gastric outlet obstruction in infants with CDH. We report the first case of gastric antrum hypertrophy causing gastric outlet obstruction in an infant with CDH.

The authors present a case of an infant who was treated for recurrent vomiting following pyloromyotomy. Gastroscopic examination showed a polypoid tumour of 4-5 mm in diameter located at the antral region. The patient recovered following re-pyloromyotomy.

BACKGROUND/AIMS: To study causes of gastric outlet obstruction (GOO) in Saudi patients in a tertiary hospital. During one year (between March 2005 and April 2006), twelve patients were referred to the gastroenterology department as possible GOO. METHODOLOGY: All patients had gastroscopy, barium meal and CT scan of abdomen. All patients presented with history of repeated vomiting usually after food. Two of these patients were known to have chronic duodenal ulceration...

Upper gastrointestinal obstruction (UGIO), obstruction occurring at the level of the stomach or duodenum, represents only about 5% of bowel obstructions. As with other bowel obstructions, timely diagnosis is necessary to prevent complications including ischemia and death. Because the presenting symptoms of UGIO can be vague and nonspecific, the diagnosis may not be suspected clinically. The radiologist therefore provides immense value as the diagnosis and often the etiology of the obstruction can be ascertained through imaging...

BACKGROUND: Congenital gastric antral web and congenital pyloric atresia are rare reasons of congenital gastric outlet obstruction (CGOO). Depending on the different forms, the symptoms vary from unspecific epigastric pain to nonbilious "projectile" vomiting, ileus and failure to thrive. Throughout the years, many different treatment options are described, like simple surgical dilatation, incision or excision of the membrane, possibly combined with a pyloroplasty. PATIENTS AND METHODS: In this retrospective single-center observation study, we present 9 cases with different kinds of webs leading to CGOO...

INTRODUCTION: Pyloromyotomy is the standard care for hypertrophic pyloric stenosis. The traditional approach for this procedure is a right upper quadrant transverse incision, although other "open" approaches, such as circumumbilical or periumbilical incision have been described. The more recent approach used is laparoscopic pyloromyotomy (LP), but experience feedback is still debated and its benefits remain unproven. The aim of this study was to make a review of all our LP procedures with an objective evaluation according to the literature...

BACKGROUND: Hypertrophic pyloric stenosis (HPS) is the most common diagnosis requiring surgery in infants. Electrolytes are used as a marker of resuscitation for these patients prior to general anesthesia induction. Often multiple fluid boluses and electrolyte panels are needed, delaying operative intervention. We have attempted to predict the amount of IV fluid boluses needed for electrolyte correction based on initial values. METHODS: A single center retrospective review of all patients diagnosed with HPS from 2008 through 2014 was performed...

AIM: We hypothesized that recent trends towards earlier diagnosis of hypertrophic pyloric stenosis continued throughout the early part of the 21st century. METHODS: We reviewed the medical records of patients with HPS at a single institution during two periods: 1/03-12/05 and 4/09-7/13. RESULTS: A total of 433 patients with hypertrophic pyloric stenosis who underwent pyloromyotomy were included (modern cohort = 259; historic = 174). The two cohorts did not differ in terms of age, weight, or median time from symptom onset to physician (5 vs 6...

PURPOSE/BACKGROUND: The aim of the study is to evaluate a large series of infantile hypertrophic pyloric stenosis (IHPS) patients treated by one pediatric surgeon focusing on their diagnostic difficulties and complications. METHODS: From July 1969 to December 2003 (inclusive), the charts of 791 infants with IHPS were retrospectively reviewed. RESULTS: There were 647 (82%) males and 144 (18%) females; mean age was 38 days, median 51 (range 7 days-10 months)...

Pyloric stenosis is a common pediatric surgical problem that requires a combination of both medical and surgical attention. This article reviews the classical elements necessary to care for the patient in a safe and effective manner. A well-tested management approach that can be applied to the general surgical environment is described. Perioperative management of the patient is discussed and the currently used techniques are reviewed. Current recommendations include the routine use of ultrasonography for diagnosis, attention to the preoperative correction of electrolytes, and the use of minimally invasive techniques for treatment...

INTRODUCTION: Pyloric stenosis is a common cause of vomiting in infancy and is usually treated with a Ramstedt's pyloromyotomy. In this study we retrospectively reviewed our experience with the circumumbilical incision for the treatment of pyloric stenosis with a particular emphasis on the relation between postoperative emesis and postoperative time to feeds. MATERIAL AND METHOD: The medical records of all patients undergoing pyloromyotomy for IHPS from January 2000 to December 2008 were reviewed retrospectively...

PURPOSE: The aim of this study is to compare the outcome of 3 different approaches to pyloromyotomy in a large single institution series. METHODS: Records of consecutive patients undergoing pyloromyotomy for an 8-year period were reviewed. Patients' age, sex, weight, operating time, length of stay, number of emeses, and complications were recorded. Variables were compared between right upper quadrant (RUQ), umbilical (UMB), and laparoscopic (LAP) approaches. RESULTS: Six hundred twenty-two patients were included in the study...

Hypertrophic pyloric stenosis (HPS) is a common condition affecting infants that presents with progressive projectile nonbilious vomiting. The pyloric portion of the stomach becomes abnormally thickened and manifests as gastric outlet obstruction. The cause is unknown. Pyloromyotomy remains the standard of treatment and outcome is excellent. This article reviews the diagnostic work up and imaging, preoperative resuscitation, the various surgical approaches used, and the effect of subspecialty training on outcomes after pyloromyotomy...

Hypertrophic pyloric stenosis (HPS) may be accompanied by jaundice, a condition referred to as the icteropyloric syndrome (IPS). It has long been suspected that the etiology of IPS is an early manifestation of Gilbert's syndrome (GS). Clinical features common to both GS and IPS include jaundice precipitated by fasting and improved with feeding. Prevalence of jaundice in HPS is similar to that of clinically apparent GS in the general population. Discovery of a mutation in the promoter region of the bilirubin uridine diphosphate glucuronosyl transferase gene (UGT1A1*28) as the most common cause of GS has provided a tool to determine the role of GS in IPS...

OBJECTIVE: Ramstedt pyloromyotomy is a common operation in infants and is often done by general surgeons. We wished to determine whether there are any differences in outcome when this procedure is done by subspecialist pediatric general surgeons as compared with general surgeons. METHODS: All Ramstedt pyloromyotomies in the province of Ontario between 1993 and 2000 were reviewed. Children with complex medical conditions or prematurity were excluded. Cases done by general surgeons were compared with those done by pediatric surgeons, specifically examining hospital stay and complications...

BACKGROUND: Since its first publication in 1986, the Tan-Bianchi procedure for treatment of infantile hypertrophic pyloric stenosis has displayed a growing consensus among pediatric surgeons. However, in up to 30% of cases, the supraumbilical skin fold incision does not allow a comfortable access. Delivery through this route, a large pyloric tumor into the wound to perform a pyloromyotomy, can be fairly difficult and time consuming and may damage the gastric or duodenal serosa by tearing...

PURPOSE: The aim of this study was to compare the incidence of surgical complications (duodenal perforation, postoperative vomiting, wound infection or dehiscence, incisional hernia) between 2 different surgical techniques for the resolution of hypertrophic pyloric stenosis in children. METHODS: A clinically controlled, randomized study with follow-up from 24 to 36 months was conducted. One hundred children between 15 days and 2 months old, who underwent surgical resolution of hypertrophic pyloric stenosis, were put randomly into 2 groups: I, pyloric traumamyoplasty (n = 43); II, Fredet-Ramstedt pyloromyotomy (n = 57)...