Pyloric Stenosis Research Articles

SARCINA VENTRICULI-RELATED GASTRITIS: A RARE CASE OF GASTRIC INFECTION IN A PATIENT WITH DELAYED GASTRIC EMPTYING

Sarcina ventriculi (SV), which is also called Clostridium ventriculi, is a rare, non-motile, aerobic, Gram-positive coccus that breaks down carbohydrates through fermentation. It thrives in acidic environments, making the human stomach a suitable habitat, particularly in conditions associated with gastric stasis. SV belongs to the Clostridiaceae family. Recent studies have implicated Sarcina ventriculi in severe gastrointestinal conditions, including emphysematous gastritis, pyloric stenosis, gastroparesis, gastric outlet obstruction, gastric perforation, and gastric adenocarcinoma. Increased awareness of this organism and further studies are essential to understanding its role in human disease.

VS 01 - BN Chronic loop gastrojejunostomy volvulus masquerading as a Crohn’s stricture

Abstract Background A video presentation of a case of chronic loop gastrojejunostomy volvulus masquerading as a Crohn's stricture. Method 61 year old female with a previous loop gastrojejunostomy and subsequent ileocaecal resection for Crohn's related pyloric stenosis and terminal ileal stricture. Acute worsening of post-prandial pain and vomiting 5 years later, re-investigation revealed a stenosed gastrojejunostomy thought to be Crohn's related. Results Intraoperative volvulus of the gastrojejunostomy was demonstrated related to traction forces resulting in the migration of the duodeno-jejunal flexure to the right of midline. The gastrojejunostomy was revised to a Roux-en-Y configuration with relief of mechanical obstruction. Conclusion An ileocaecal resection may create unexpected traction forces

Pyloric index, a new parameter: predicting perioperative prognosis in neonates with hypertrophic pyloric stenosis

Purpose Delays in the diagnosis and treatment of infantile hypertrophic pyloric stenosis (IHPS) may lead to laboratory and clinical decompensation in infants. The aim of this study was to determine whether pyloric measurement parameters can be effectively used in the clinical prognosis of IHPS by evaluating the relationship between pyloric dimensions on ultrasonographic evaluation at the time of presentation and clinical and laboratory parameters in infants with pyloric stenosis. Methods A retrospective observational study was conducted on 122 infants who were followed up with the diagnosis of IHPS in our neonatal clinic and operated on by a pediatric surgeon between January 2005 and December 2020. Results The mean pyloric dimensions of the infants were pyloric length 20 mm (17–22), pyloric thickness 5 mm (4–5.8), and pyloric index 96.5 (72.2–124). Babies with preoperative laboratory values of hypokalemia, hypochloremia and metabolic alkalosis had statistically higher pyloric thickness >5 mm (4.1–6) and pyloric index >100 (86–130) parameters. Conclusion Pyloric thickness and pyloric index parameters can predict clinical prognosis in babies diagnosed with IHPS in the perioperative period.

Utility of preoperative prophylactic antibiotics for preventing surgical site infections in children with infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis.

The aim of this study was to determine the utility of prophylactic antibiotics before pyloromyotomy for the prevention of Surgical Site Infections (SSI) among children with Infantile Hypertrophic Pyloric Stenosis (IHPS). A systematic search of PubMed, Scopus, Embase, and Web of Science databases was performed to identify papers published till 30th July 2024. The main outcome of interest was the incidence of SSIs. The relative risk (RR) with 95% confidence interval (CI) was calculated using a random effects model. The I2 statistic was used to calculate the heterogeneity. The Newcastle-Ottawa-Scale (NOS) was used to assess the methodological quality of the included studies. Five studies, published between 1999 and 2024, were included in this systematic review and meta-analysis. The risk of developing SSI among those treated was RR = 0.97, 95% CI 0.53 to 1.78, with I2 = 0%, indicating no incremental benefit of administration of prophylactic antibiotics. A sensitivity analysis was performed by excluding the database studies. Results from this analysis (RR = 0.79, 95% CI 0.29 to 2.20, I2 = 0%) demonstrated that no significant difference was observed after excluding studies with large sample sizes. All included studies were of good methodological quality as assessed with the NOS. The findings of this review demonstrate no incremental benefit of the administration of prophylactic antibiotics before pyloromyotomy in preventing SSIs in children with IHPS. However, randomized, double-blinded, placebo-controlled trials need to be conducted in the future before any definite conclusions are drawn in this regard.

Operative Procedures and Postoperative Complications in Patients with Gastric Outlet Obstruction

Background: Gastric outlet obstruction denotes complete or partial obstruction of the distal stomach, pylorus, or proximal duodenum. This can happen as a result of an obstructing lesion, external compression, or obstruction caused by acute edema, chronic scarring and fibrosis, or a combination of the two. The most common causes of gastric outlet obstruction are gastric cancer and pyloric stenosis secondary to peptic ulceration. We have very limited research-based information regarding postoperative complications in patients with gastric outlet obstruction. Aim of the study: This study was carried out to determine the operative procedures and postoperative complications in patients with gastric outlet obstruction. Methods: Between September 2012 to February 2013, this prospective observational study was carried out in the surgery department of Rangpur Medical College Hospital, Rangpur, Bangladesh. A total of 50 patients presenting with the features of gastric outlet obstruction were included in this study. A convenient purposive sampling technic was used in sample selection. In 27 patients, surgery was performed. Registration schedules, editing computerization, preparing dummy tables, and analyzing and matching data were all part of the data processing work. Results: In the cases of benign gastric outlet obstruction, bilateral truncal vagotomy and retro colic isoperistaltic gastrojejunostomy were preferred. Distal partial gastrectomy with lymph node dissection was done in resectable antral growth of the stomach. Palliative gastrojejunostomy was done in advanced gastric and pancreatic malignancy. Gastrojejunostomy with biopsy from the duodenum and lymph node was taken from one pre-operatively diagnosed case of duodenal tuberculosis, which was made by endoscopic biopsy. Complication occurred mostly in the malignant cases; 7 (43.75%) patients developed wound infection, of which 5 (31.25%) patients developed wound dehiscence. There was a duodenal stump-blow out in ...

Exclusive pyloric stenosis: A rare presentation of gallbladder cancer

Exclusive pyloric stenosis: A rare presentation of gallbladder cancer

Rare Diseases and Syndromes Observed in Newborn Babies with Idiopathic Hypertrophic Pyloric Stenosis.

Although infantile hypertrophic pyloric stenosis is a multifactorial disease caused by genetic and environmental factors, the role of genetic factors has become more important recently. With this study, we aimed to present rare diseases accompanying infantile hypertrophic pyloric stenosis caused by genetic factors. This is a retrospective study. Babies who were operated on with the diagnosis of infantile hypertrophic pyloric stenosis in the neonatal intensive care unit between 2000 and 2022 and had additional diseases were included in the study. 9.8% of patients diagnosed with infantile hypertrophic pyloric stenosis had an accompanying rare disease. Early diagnosis and treatment of rare diseases associated with infantile hypertrophic pyloric stenosis are of great importance in reducing morbidity/mortality due to these diseases.

A rare case of Wilkie`s syndrome with infantile hypertrophic pyloric stenosis

Wilkie’s syndrome is a rare clinical disorder characterized by partial or complete obstruction of the duodenum. Infantile hypertrophic pyloric stenosis (IHPS) is defined as hyperplasia of the smooth muscle fibers of the pylorus, which is considered responsible for narrowing the pyloric canal and eventually obstructing the gastric outlet. This paper presents a case of a 3-month-old boy who had been vomiting after feeding for one month. The main symptoms, postprandial vomiting, dehydration, alkalosis, and weight reduction, point to the IHPS disease. Imaging studies also confirmed the diagnosis. During the surgical treatment, a concomitant condition known as Wilkie’s syndrome was also evidenced. The team performed a complex surgical treatment of a patient diagnosed with both Wilkie’s syndrome and IHPS within one single surgical operation. Surgical treatment with pyloromyotomy and duodenal-duodenal anastomosis within one operation is an optimal option for one-stage treatment of patients with IHPS and Wilkie’s syndrome.

Treatment outcome and associated factors of infantile hypertrophic pyloric stenosis at eastern Ethiopia public hospitals

BackgroundInfantile hypertrophic pyloric stenosis (IHPS) is a condition whose etiology is not clear, but it is characterized by progressive hypertrophy of the circular muscles of the pylorus with consequent obstruction of the gastric outflow, mostly in neonates and infants under the age of one year.ObjectivesTo assess the treatment outcome and associated factors of infantile pyloric sphincter stenosis among paediatric patients admitted to HFCSUH and JUSHYRH.MethodologyA retrospective patient record review with 78 participants was studied consecutively using a structured questionnaire. The data was processed and analyzed using Epi Info 7 and SPSS version 24. Descriptive analysis was done, and then associated factors to the outcome were assessed using logistic regression analysis. The association’s significance was determined using an odds ratio with a 95% confidence interval and a P-value less than 0.05. The study period was from November 1st to 30th, 2022.ResultsThe magnitude of unfavorable IHPS was 17.1% with a 95% confidence interval of 16.7–23.9%. Hypokalemia (AOR = 2.3, CI = 3.015–19.54), severe dehydration (AOR = 30.9, CI = 2.89–31.75), and delayed presentation (AOR = 7.37, CI = 2.761–12.08) were independent predictors.ConclusionsThe study found a highly unfavorable treatment outcome with delayed presentation; dehydration and electrolyte disturbance were the main predictors of poor outcome. It is recommended to increase community awareness about non-bilious vomiting in infants and ensure high suspicion among healthcare providers. Moreover, following guidelines to correct fluid and electrolyte disturbances and managing these patients in the pediatric ICU postoperatively.

Benign pyloric adenomyoma presented as gastric outlet obstruction: a case report and review of the literature

BackgroundGastric adenomyoma is a rare benign tumor composed of glandular structures and smooth muscle fibers. While some classify gastric adenomyoma as a hamartoma, others view it as an abortive form of heterotopic pancreas. Despite its benign nature, there is a risk of malignant transformation. Predominantly found in the antrum, gastric adenomyoma affects all ages but is most common in adults aged 40–60 years. Symptoms are nonspecific, and its similarity to other lesions complicates diagnosis. This paper aims to provide a review of medical literature on gastric adenomyoma and its diagnosis and treatment methods, along with presenting an additional case report on the same topic.Case presentationWe present the case of a 55-year-old Syrian man who experienced vomiting, weight loss, and chronic partial constipation. An obstructing mass in the pylorus was detected, and then an open surgery was performed to excise the lesion. A biopsy of the resected mass was obtained for histopathological examination. The final diagnosis of the lesion was pyloric-region adenomyoma with severe pyloric stenosis. After the successful surgery, the patient recovered without any recurrence or complications.ConclusionsSeveral diagnostic approaches are available, including radiological studies, endoscopic examination, and fine needle aspiration guided by endoscopic ultrasonography. Treatment options involve endoscopic submucosal dissection and complete laparotomy resection. Further studies and thorough reviews are recommended to better understand the best clinical practices. Practitioners should consider gastric adenomyoma when encountering a mural gastric lesion.

A clinical case report of aberrant pancreas in the practice of a general practitioner

An aberrant pancreas is a fairly rare developmental anomaly, which, de spite its congenital genesis, is most often found in people of the middle age group. The article presents a clinical case of an aberrant pancreas with localization in the antrum of the stomach in a 52-year-old patient. Congenital pathology has an asymptomatic course for a long time, which is subsequently associated with late diagnosis and the need for a comprehensive examination of the patient. Despite the long-term symptomless course of the pathology, the secretory activity of the ab errant pancreas contributes to persistent inflammation of the gastric and duodenal mucosa, potentiates irreversible pathological changes, and increases the risk of complications, including gastric intestinal metaplasia. The patient under consider ation was diagnosed with a multimorbid chronic pathology of the gastrointestinal tract, which, despite ongoing therapy, was characterized by frequent exacerbations. Due to the established diagnosis, it was possible to prescribe successful conser vative treatment and avoid surgical intervention in this patient. According to the literature, differential diagnosis with malignant neoplasms is necessary. The choice of surgical treatment tactics is determined by the development of complications, among which both obstructive complications (dysphagia, pyloric stenosis, intus susception, intestinal obstruction, obstructive jaundice) and complications specific only to pancreatic tissue, such as pancreatitis, cysts and pseudocysts, ulcerative defects with perforation of the hollow organ, benign and malignant neoplasms, are described. The question of the expediency of surgical treatment of patients in the absence of complications remains debatable to the present day, which causes diffi culties in the management of these patients.

Prepyloric gastric antral muscular ring in an infant.

We present a unique case of a prepyloric gastric muscular ring, a pathology distinct from a gastric web. There is scarcity of literature on this topic, nearly all cases of prepyloric antral rings or webs published in literature are mucosal or submucosal in nature with no evidence of muscle hypertrophy. Given the prevalence of pyloric stenosis as the most common gastric outlet malformation in neonates, gastric rings and webs are not readily considered in the differential diagnosis of gastric outlet obstruction. While most cases of gastric outlet obstruction are diagnosed radiologically, less common pathologies will be confirmed with direct visual inspection during surgery. The term "congenital gastric outlet obstruction" has been used to encompass rare cases, making it appropriate to include a muscular ring in this category. We propose the term "gastric ring" be used with a semantic modifier of "muscular" versus "submucosal/mucosal" to avoid confusion.

A new neonatal gastro-intestinal physiology-and pyloric stenosis of infancy a hypothesis

The outside world carries many dangers for the new-born baby especially in primitive societies. One danger undoubtedly is the risk of serious early enteric infections. Neonatal gastric acid is the principal defense.This author proposes that this acid defense is increased in two main ways;1. An immediate temporary acidity created by maternal gastrin transfer during spontaneous labor.2. A progressively rising acidity which culminates in a temporary peak acidity at approximately 3 weeks and is due to a late maturation of the negative feed-back between gastrin and gastric acidity.The author contends that there is an immature negative-feed-back between neonatal gastrin and gastric acidity at birth which matures around 3 weeks of life. Until maturity, both gastrin and acid secretion rise without restraint.In this way rising gastrin will stimulate acid secretion as well as enhance the development of gastric parietal cells to allow them, after feed-back matures, to independently provide an acid defense.One consequence of this new physiology is that it allows us to simply explain why pyloric stenosis of infancy occurs--the most common and hitherto unexplainable cause of milk vomiting in the neonate.

Effectiveness of two-dimensional shear-wave sonoelastography in the diagnosis and follow-up of infantile hypertrophic pyloric stenosis

IntroductionWe sought to determine the effectiveness and utility of two-dimensional shear-wave sonoelastography (2D-SW-SE) in the diagnosis and postoperative follow-up of infantile hypertrophic pyloric stenosis (IHPS).Materials and MethodsTwenty-three infants were included in the study, 13 in the IHPS group and 10 in the control group (CG). Preoperative B-mode ultrasonography measurements (longitudinal length and single-wall thickness of the pylorus) and 2D-SW-SE measurements (pylorus tissue stiffness and shear-wave propagation speed) were compared between the groups. The infants with IHPS then underwent Ramstedt pyloromyotomy and were invited for follow-ups on the tenth day and the first, third, and sixth months postoperatively. Measurements taken at the follow-ups were compared with the preoperative values.ResultsNo differences were found between the groups regarding age, gender, body weight, or week of birth. The pyloric lengths in the IHPS group were longer than in the CG (p < 0.001), and the single-wall thicknesses were thicker (p < 0.001). The pylorus in the IHPS group was four times stiffer than in the CG (27.4 kPa versus 7.66 kPa), and the shear-wave propagation speed in the tissue was higher (1.34 m/s versus 2.69 m/s; p < 0.001). Both values decreased over time in the IHPS group and were normal by the third postoperative month.Conclusions2D-SW-SE can be used as an assistive imaging tool alongside B-mode ultrasound for diagnosing IHPS. It can also be used to identify inadequate surgery by detecting whether the pyloric tissue has softened at follow-up.

Inflammatory status predicts prognosis in patients with gastric cancer with early pyloric stenosis who underwent radical resection: A propensity score‑matching analysis.

The inflammatory status of patients is closely related to their nutritional status, and the impact of inflammatory status on patients with pyloric stenosis remains unclear. The present study aimed to investigate the impact of inflammatory status on the prognosis of patients with gastric cancer with early pyloric stenosis who underwent radical resection. A retrospective analysis included 242 patients with gastric cancer who underwent radical resection at the Affiliated Hospital of Southwest Medical University between July 2016 and December 2020. All patients were diagnosed with early pyloric stenosis. Correlation analysis was used to assess variations among different factors, and survival analysis was conducted to evaluate differences in overall survival (OS). To identify independent prognostic indicators, both univariate and multivariate Cox regression analyses were performed, addressing potential multicollinearity using Lasso analysis. Propensity score matching (PSM) was employed to eliminate potential confounding factors. Additionally, a prognostic risk model and nomogram based on inflammatory indicators were developed to comprehensively explore their impact on prognosis. Initial survival analysis revealed significant associations between neutrophil-to-lymphocyte ratio (NLR; χ2=10.522, P<0.001), systemic immune-inflammation index (SII; χ2=6.733, P=0.025), systemic inflammation response index (SIRI; χ2=15.490, P<0.001) and OS of the patients, while there was no significant survival difference among patients with different platelet-to-lymphocyte ratio (PLR; χ2=2.561, P=0.050). SIRI not only had the highest area under the curve but was also found to be an independent prognostic indicator (hazard ratio=1.851, P=0.046) in the present study. Following PSM on SIRI, a total of 174 patients were included in the subsequent analysis. Time-receiver operating characteristic and survival curves for SIRI after PSM consistently demonstrated its robust prognostic predictive capability. Furthermore, the prognostic risk model based on SIRI and the nomogram incorporating SIRI both exhibited high prognostic value. Inflammatory status was significantly associated with the prognosis of patients with gastric cancer with early pyloric stenosis who underwent radical resection. The NLR, SII and SIRI could all predict patient outcomes. Moreover, SIRI exhibited the highest prognostic value among the inflammatory indices and has been identified as an independent prognostic factor in the present study.

Disparities in insurance status negatively affect patients with infantile hypertrophic pyloric stenosis.

Infantile hypertrophic pyloric stenosis (IHPS) is suspected to have worse outcomes when length of illness prior to presentation is prolonged. Our objective was to evaluate how social determinants of health influence medical care and outcomes for babies with IHPS. A retrospective review was performed over 10years. Census data were used as proxy for socioeconomic status via Geo-Identification codes and correlated with food access and social vulnerability variables. The cohort was subdivided to understand the impact of Medicaid Managed Care (MMC). The cohort (279 cases) was divided into two groups; early group from 2011 to 2015 and late from 2016 to 2021. Cases in the late group were older at the time of presentation (41.5 vs. 36.5days; p = 0.022) and presented later in the disease course (12.8 vs. 8.9days; p = 0.021). There was no difference in race (p = 0.282), gender (p = 0.874), or length of stay. Patients who presented with IHPS after implementation of phased MMC were older, had a longer symptomatic course, and shorter pylorus measurements. Patients with public insurance after the implementation of MMC were more likely to follow-up with an outpatient pediatrician within a month of hospitalization. These results suggest that MMC may have improved access to care for infants with IHPS.

Ultrasound typical aspect of hypertrophic pyloric stenosis

A 3-week-old boy was admitted to the pediatric emergency department for vomiting and dehydration. There was no medical history records, the toddler was only breastfed and clinical signs appeared a week prior through non-bilious, projectile curdled milk emesis happening shortly after feeding, associated to clinical signs of dehydration and weight loss.

Incidental finding of thyroglossal duct cyst in a neonate during endotracheal intubation: a case report

BackgroundThyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient.Case presentationa 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk’s procedure to avoid future complications and anesthesia.Conclusionseven if TDC is a common lesion of pediatric patients, anecdotical neonatal cases were described in the literature, all of them symptomatic. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk’s procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.

Gastric pneumatosis and aeroportia in gastroparesis with recurring functional pyloric stenosis.

Gastric pneumatosis and aeroportia in gastroparesis with recurring functional pyloric stenosis.

Neonatal acidity and pyloric stenosis of infancy (PS) - the beginning and the end two stories

Neonatal acidity and pyloric stenosis of infancy (PS) - the beginning and the end two stories