Hiatus Hernia and the Pyloric Sphincteric Cylinder

Abstract

Roviralta (1951) described three cases of partial thoracic stomach in infants associated with hypertrophic pyloric stenosis (IHPS), and called the combination the phrenopyloric syndrome. It was believed that raised intragastric pressure secondary to the obstruction at the pylorus forced the stomach into the chest. Among 115 children with a partial thoracic stomach, Astley and Carre (1954) encountered five who also had hypertrophic pyloric stenosis, while another three had “infantile pylorospasm”. The pylorospasm in all three patients was described as an inconstant narrowing of the pyloric “antrum”, (Chap. 20), the radiographic appearance simulating IHPS to such a degree that Astley (1956) later called them cases of pseudohypertrophic pyloric stenosis. The symptomatology suggested that initially there was gastroesophageal reflux due to a partial thoracic stomach, followed by the superimposition of hypertrophic stenosis a few weeks later. Thus vomiting commenced soon after birth, and at the age of 2–3 weeks the symptoms and signs of hypertrophic stenosis, such as projectile vomiting, visible peristalsis and a palpable mass were superadded.