Atresia of the antral and pyloric parts of the stomach

Abstract

Introduction. Congenital obstruction of the gastric outlet is one of the rarest surgical diseases in newborns. Its incidence ranges from 0.003% to 1% of all cases of gastrointestinal atresias. This congenital malformation has several anatomical forms and divides into antral and pyloric atresias.Etiology. There is no any unified opinion as to the origin of atresia in the gastric outlet. Several concepts are known to suggest possible causes of the impaired patency of gastric outlet. Among them, there are genetic factors, intrauterine mesenteric ischemia, epidermolysis bullosa.Material and methods. The analysis of 55 literary sources is carried out.Results. The most common systematization of various forms of antral and pyloric atresia divides them into membranous forms (type I), solid forms without diastasis (type II) and forms with diastasis between segments (type III). Gastric outlet atresia can be diagnosed before birth if polyhydramnios and stomach dilatation are revealed at examination. The main diagnostic sign of the abnormality after birth is the radiographic symptom of “a single bubble”. The technique for patency restoration of the stomach distal parts is chosen depending on the anatomical type of obstruction: for pyloric and antral type I atresia, it is recommended to perform membranectomy and pyloroplasty by Heineke–Mikulicz technique; in pyloric atresia of type II and III, gastroduodenal anastomosis is put. Recently, new alternative techniques for restoring the patency of gastric outlet lumen have appeared, namely, laparoscopy and intraluminal endoscopy. Conclusion. Thus, atresia of the gastric antrum and pylorus are fairly rare congenital diseases. Surgical strategies for correcting these abnormalities envisage membranectomy or gastroduodenoanastomosis. A perspective direction in the care of elective cases of congenital gastric outlet obstruction is intraluminal endoscopy and laparoscopy