Unusual pyloric obstruction in children. Report of six operated cases

Abstract

Hypertrophic pyloric stenosis (HPS) is a condition present in approxi- mately 0.25-0.5% of all live newborns 1. It usually presents between the third and the twelfth weeks of extrauterine life, predominantly in males in a 4:1 ratio. HPS results from a hypertrophy of the muscle layer, the etiology is unknown and leads to high intestinal obstruc- tion 2. Pyloric obstruction (PO) is present beyond the age-range for HPS, its frequency is unusual, its incidence is unknown, and in most cases it is secondary to other pathologies 1,3. We present six patients between the ages of four months and four years, with pyloric obstruction (PO) seen at the Instituto Nacional de Pediatria, between January 2005 and January 2010. The main post-surgical diagnoses of these cases were fenestrated antral membrane, and pyloric obstruction secondary to peptic ulcer di- sease. While HPS is well known among pediatricians, there are still patients diagnosed very late, as was case-study number 1 in our series. The procedures used in patients with PO were Heineke Mickulicz antropyloroplasty, Jaboulay gastroduodenal anastomosis and Fin- ney pyloroplasty, with good post-surgical results after an average 6 months follow-up.