Congenital Pyloric Antral Membranes in Infancy

Abstract

IN THIS communication we will describe 2 cases of congenital pyloric antral membranes presenting in the neonatal period. In both instances a pylorectomy with endto- end anastomosis was performed. In the second case, a correct preoperative diagnosis was made radiologically. This is the first case believed to have been so diagnosed at this age; indeed, although the condition is now well known only one other case of incomplete pyloric membrane has been recorded in the neonatal period (6). Case Reports CASE I: In May 1965 a premature Negro 3-dayold female presented with repeated non-bile-stained vomiting. Normal stools were being passed. There was slight epigastric fullness. A plain radiograph showed a distended stomach with relatively little gas in the small intestine. The stomach was aspirated, and a contrast examination was performed with a water-soluble medium. There was no gastric emptying for forty-five minutes. Later, an elongated segment was demonstrated, and an erroneous diagnosis of hypertrophic pyloric stenosis was made (Figs. 1 and 2). At surgery a prepyloric membrane with a central aperture of 2 mm was found. The histology of the membrane was that of normal gastric mucosa. There was no evidence of muscle hypertrophy. CASE II: In June 1967, a 4-day-old Negro male was seen. The birth was normal, but the mother had hydramnios. The patient had been vomiting since birth, the vomiting becoming projectile in character during the last twenty-four hours. The vomiting was not bile-stained, and motions were normal. There was slight dyspnea. Plain films showed a fluid level in the stomach, the rest of the abdomen being relatively airless. There was slight bronchopneumonia in the chest. A limited amount of dilute barium sulfate suspension was instilled down an intragastric tube. Esophageal reflux occurred, and vigorous peristalsis was noted in the stomach. The pyloric region was round and blunted. There was marked delay in gastric emptying, and it was not until after one hour that a central linear streak of barium emerged from the pyloric region (Figs. 3 and 4). From these appearances a diagnosis of prepyloric membrane was made. At surgery the pyloric canal was opened, and a thin membrane with a small central aperture was found to be obstructing the pylorus. The histology of the membrane was that of normal gastric mucosa; no muscle hypertrophy was seen. Discussion The pyloric membranes described are congenital in origin and present as a neonatal emergency. The membranes may be incomplete (as in these two cases) or complete. In the neonatal period, the clinical features are of upper gastrointestinal obstruction. Dyspnea, cyanosis, excess salivation, and aspiration may also occur. In the diagnosis esophageal atresia can be excluded by passing a catheter. Bilestained vomiting excludes 85 per cent of duodenal atresias (those distal to the ampulla of Vater).