Treatment Of Pyloric Stenosis Research Articles

Diagnosis and surgical correction of pyloric stenosis in a dog – a case study

Pyloric stenosis, which could occur as a congenital or acquired condition, is more common in dogs when compared with other domestic animals. This condition has not been reported in Sri Lanka probably due to unfamiliarity with it and lack of diagnostic facilities. This communication discusses the clinical signs, radiographic and ultrasonographic findings, and treatment of pyloric stenosis in a one-year old female Cocker Spaniel presented to the Veterinary Teaching Hospital (VTH), Peradeniya. The patient developed projectile vomiting and distended, gas filled abdomen after meals as clinical signs. Survey radiographic findings included the 'gravel sign' in the stomach. In ultrasonography, thickened pylorus was observed. Contrast radiographs after oral administration of barium sulphate suspension showed a delay of gastric emptying. All the above findings suggested that the patient had pyloric stenosis. Complete blood count and serum biochemistry demonstrated no abnormalities. Surgical intervention was performed as treatment, using Fredet-Ramstedt pyloromyotomy together with Heineke-Mikulicz pyloroplasty to clear the obstruction in the pyloric canal. Since there were no post-surgical complications, patient was discharged in 4 days following the surgery. The prognosis was satisfactory and the animal has been healthy after the surgery. The pyloric stenosis observed in this case could be congenital, with hypertrophy and subsequent stenosis gradually worsening over time.

The treatment of pyloric stenosis: Evolution in practice.

Over the last hundred years, idiopathic hypertrophic pyloric stenosis has undergone an evolution in treatment, with subsequent improvements in outcome. Initially, it was treated by physicians with antispasmodics and various alternative feeding and resuscitation modalities. The evolution of surgical approaches led to a revolution in outcome, from almost certain death to complete cure. The progression of surgical and medical treatments is reviewed in this article until, ultimately, Ramstedt's pyloromyotomy is reached. This distilled operation has remained the gold-standard procedure for over a century.

Perioperative care of infants with pyloric stenosis.

Pyloric stenosis (PS) is one of the most common surgical conditions affecting neonates and young infants. The definitive treatment for PS is surgical pyloromyotomy, either open or laparoscopic. However, surgical intervention should never be considered urgent or emergent. More importantly, emergent medical intervention may be required to correct intravascular volume depletion and electrolyte disturbances. Given advancements in surgical and perioperative care, morbidity and mortality from PS should be limited. However, either may occur related to poor preoperative resuscitation, anesthetic management difficulties, or postoperative complications. The following manuscript reviews the current evidence-based medicine regarding the perioperative care of infants with PS with focus on the preoperative assessment and correction of metabolic abnormalities, intraoperative care including airway management (particularly debate related to rapid sequence intubation), maintenance anesthetic techniques, and techniques for postoperative pain management. Additionally, reports of applications of regional anesthesia for either postoperative pain control or as an alternative to general anesthesia are discussed. Management recommendations are provided whenever possible.

Current trends in the diagnosis and treatment of pyloric stenosis.

We hypothesized that recent trends towards earlier diagnosis of hypertrophic pyloric stenosis continued throughout the early part of the 21st century. We reviewed the medical records of patients with HPS at a single institution during two periods: 1/03-12/05 and 4/09-7/13. A total of 433 patients with hypertrophic pyloric stenosis who underwent pyloromyotomy were included (modern cohort = 259; historic = 174). The two cohorts did not differ in terms of age, weight, or median time from symptom onset to physician (5 vs 6.5 days; p = 0.3) or surgeon (7 days for both) evaluation. The percentage of patients who presented late (>7 days of symptoms) (27 % modern vs 25 % historic; p = 0.15) or with an elevated serum bicarbonate (22 % for both; p = 0.8) did not change over time. There was a shift to laparoscopic procedures: 99 % modern vs 57 % historic (p < 0.0001) with no associated change in operative length (28 vs. 27 min; p = 0.06), or operative (3 % for both, p = 0.8) or respiratory (4 vs 2 %, p = 0.4) complications. Most infants with hypertrophic pyloric stenosis are diagnosed early, prior to significant electrolyte abnormalities; however, continued improvement in awareness is necessary given that a fourth of patients are diagnosed after over 1 week of symptoms.

Images in Anesthesiology: Pyloric Stenosis

University of Massachusetts Medical Schoollance. lichtor@umassmed.eduIN pyloric stenosis, which usually occurs during the first 1–3 months of life, the circular muscle of the pyloris hypertrophies, the gastric outlet constricts and then it is obstructed. This leads to nonbilious, projectile vomiting, which usually occurs after feeding. Because of repeated episodes of vomiting, both hydrocholoric acid and fluids are lost, which leads to hypochloremic metabolic alkalosis.Often a pyloric mass can be palpated in the epigastrium or right upper quadrant, beneath the liver edge. As a complement to physical examination, ultrasound is the method of choice for both diagnosis and exclusion of diagnosis because the pyloris is directly visualized (fig. 1). Indeed, ultrasound has almost become a substitute for physical examination and it may also be responsible for earlier diagnosis.1Compared with a fluoroscopic examination, ultrasound does not expose the patient to ionizing radiation, and oral contrast that can be aspirated is not required.Pyloromyotomy is the treatment of pyloric stenosis. The operation should never be treated as an emergency. Although electrolyte status should be checked preoperatively and should be treated before surgery, the percentage of these patients presenting with abnormal electrolytes is decreasing. As it is apparent from the ultrasound, the child should be treated as if the patient has a full stomach. Indeed, in one study, gastric fluid measured after induction of anesthesia averaged almost 5 ml/kg and 85% had volumes more than 1.25 ml/kg.2Many use that study to recommend orogastric suctioning before rapid sequence induction of general anesthesia. Although in the past some have recommended that tracheal intubation should be performed while awake, complications are similar to that of the rapid sequence induction used.3

Access to the Hypertrophic Pylorus: Does It Make a Difference to the Patient?

The aim of the study was to evaluate the effects of different access methods for the treatment of pyloric stenosis (PS). Since 2001, we have operated on children with PS using three different access methods: classic right upper quadrant transverse incision (TI), incision on the superior umbilical fold (UI) and laparoscopic (L). We reviewed the records of these children with special emphasis on the number and characteristics of complications, operative time, and length of stay (LOS). We identified 256 patients (212 M, 44 F) with a mean age of 36 days. 138 procedures were performed using TI, 18 with UI and 100 laparoscopically. The mean operative time for patients with TI was 35.9 +/- 8.6 min, and for those with UI 31.8 +/- 9.3 min. Patients in the L group had a mean operative time of 29.8 +/- 11 min. Although the operative time for TI was significantly greater than that of L, the differences between the TI and UI groups and between UI and L groups did not reach statistical significance. For the TI, UI and L groups, the mean overall LOS was 3.22 +/- 0.3 days, 3.39 +/- 0.4 days and 2.94 +/- 0.2 days, and the mean postoperative LOS was 1.52 +/- 0.1 days, 1.44 +/- 0.2 days, and 1.56 +/- 0.1 days, respectively. No significant difference in LOS was found. One patient from each group had a wound infection. While three of four perforations occurred in the L group and the fourth was in the TI group, the difference in rates of perforation among the groups did not achieve statistical significance. The perforation during open surgery was typical, occurring on the duodenal end during spreading of the pyloric muscle. The perforations in the L group were atypical: one was a grasper injury to the duodenum; another was on the gastric end of the pyloric incision and the third occurred not during spreading of the pyloric muscle but during the cutting of it. The pylorus was relatively small in this particular case (12 mm in length). While the operative time of laparoscopic repair for PS is less than in either of the open approaches, laparoscopic surgery may increase the risk for atypical injuries to the bowel. Therefore, proper attention should be paid to dissection of the structures and the selection of laparoscopic instruments. Incision on the superior umbilical fold is a reasonable alternative access for the treatment of PS.

Highly selective vagotomy and pyloric dilatation for duodenal ulcer with stenosis

This paper presents the results obtained in 15 patients with duodenal ulcer and stenosis who were treated more than 3 years ago by highly selective vagotomy (HSV) and dilatation of the stenosis without a gastric drainage procedure. Patients were taking solid food 3--6 days postoperatively and were discharged after 7--14 days. There have been no recurrent stenoses. Fourteen of the 15 patients were Visick grade 1 or 2 at their last visit. One patient has a recurrent ulcer, but no restenosis. Barium meals performed on 6 patients with severe stenosis preoperatively showed satisfactory gastric emptying 1--3 years postoperatively. HSV and pyloric dilatation seems to be a safe and effective procedure for the treatment of pyloric stenosis due to chronic duodenal ulceration.

Pyloric Stenosis in Premature Infants

The diagnosis and treatment of pyloric stenosis in infants has been well established for many years. 1 The incidence of pyloric stenosis in premature infants is unusual, 1 the presentation is atypical, 2-5 and the diagnosis delayed, if not difficult. 2-5 Recently, four premature infants with pyloric stenosis demonstrated these features and underscored the limitations of ultrasonographic imaging in premature infants. 5,6 Patient Reports. Patient 1 . A premature male infant (weighing 2100 g at 35 weeks' gestation) with the onset of nonprojectile vomiting at 6 weeks of age was evaluated by ultrasound at 7 weeks of age. Ultrasound findings were normal (pyloric muscle thickness, 2.4 mm), and vomiting persisted. An upper gastrointestinal contrast study performed at 8 weeks of age confirmed pyloric stenosis. Patient 2 . A premature male infant (weighing 1610 g at 31 weeks' gestation) with the onset of nonbilious nonprojectile vomiting at 5 weeks of age was evaluated

Pyloric and oesophageal dysfunction in the cat.

ABSTRACTThe paper describes the symptoms, diagnosis and treatment of pyloric stenosis in thirteen cats, associated in some animals, with megalo‐oesophagus.

The treatment of pyloric stenosis in peptic ulcerations.

The treatment of pyloric stenosis in peptic ulcerations.

Treatment of Pyloric Stenosis in Infants with Methylscopolamine Nitrate

Summary.Methylscopolamine nitrate has proved to be a superior antispasmodic in internal medicine, and it therefore seemed likely that it might be equally valuable in pediatric practice, in particular in the treatment of infantile pyloric stenosis. In 6 of the 9 patients treated immediate cessation of the vomiting, improvement in the general condition, and a gain in weight was achieved. Three patients did not respond to the treatment and an operation was necessary. The most striking feature was the rapidity with which the effect occurred. In many of the infants it occurred on the same day as the first dose, and in any case an improvement was noted within a few days. Another quality of this drug which makes it especially suitable for use in children is its harmlessness. Not even after a long period of medication were any by‐effects to be observed, other than a sudden flush which rapidly subsidedThe drug has also been tried and proved to be very effective in the treatment of other forms of vomiting occurring in infancy.

The Treatment of Pyloric Stenosis

HIS condition, known also as congenital stenosis of the pylorus, (constriction or narrowing of the pylorus muscle of the stomach), or simply pyloric stenosis of infancy, is not uncommon. It is characterized by persistent vomiting, constipation, marked visible gastric peristalsis, usually a palpable tumor, loss of weight, restlessness, poor skin turgor, irritability, and wasting which may ultimately develop into marasmus. It has a serious prognosis and unless recognized and treated properly has a high mortality. It occurs in early infancy in the first two months of life but seldom in the first two weeks. Fully three-fourths of the cases reported are male infants. The condition has no relation to the type of feeding. Symptoms may begin in the first week of life, but the usual history is that of an infant who has given no evidence of gastric disorder and often has been nursing and gaining regularly in weight and who begins to vomit without evident cause. At first this happens occasionally; then habitually. The vomiting becomes forcible and projectile. Medical treatment is usually given a faithful trial-that is, diet and stomach lavage before surgical intervention. This condition is differentiated from pylorospasm which appears in later months of infancy, can be controlled by specific medication, and its symptoms are not so radical. In pyloric stenosis it is of tremendous importance to have the infant cared for intelligently and competently before and after surgery. Therefore it is imperative that the nurse understand the treatment clearly. The following outline of procedure has been satisfactorily carried out in the p diatric department at the Mount Sinai Hospital, Chicago, Illinois. Medical treatment.-Due to the extreme loss of weight, associated with vomiting, the medical and dietary treatment is an outstanding point of observation. Daily weighing is essential. The regulation of food and maintenance of body weight and resistance are important. The diet consists of thick cereal

The Treatment of Pyloric Stenosis

The Treatment of Pyloric Stenosis

Operative Treatment of Pyloric Stenosis

Operative Treatment of Pyloric Stenosis

A FURTHER CONTRIBUTION TO THE STUDY OF PYLORIC STENOSIS

The treatment of pyloric stenosis is a topic which is still very much under discussion. This is mainly due to the fact that some clinicians advocate immediate operation while others get excellent results in many cases without such a radical procedure. Good results are often obtained without surgery because the spasm frequently relaxes when certain dietary measures are instituted. Operation, soon after the diagnosis is made, doubtless subjects many infants to unnecessary operation. On the other hand, persistence in unsuccessful feeding may increase the surgical risk. The statement occasionally made by some pediatricians that the diagnosis of pyloric stenosis is synonymous with indication for operation is not in accord with the opinion held by the foremost surgeons in this field. Thus Downes,¹points out very clearly that medical treatment is justifiable for a period of from seven to ten days, provided the patient does not lose too much weight

A Method of Obtaining Cultures from the Duodenum of Infants

Ever since Escherich' published his classic monograph on the flora of the intestine during infancy, this field has been a favorite one for bacteriologists. They have, however, found themselves hampered not only by the difficulties attendant on growing intestinal bacteria, but by the difficulty of isolating pathogenic organisms from the multitude of saprophytic bacteria which flourish in the lower intestinal tract. Bearing this in mind, it seemed as if the duodenal catheter, devised primarily for the purpose of the diagnosis and treatment of pyloric stenosis, might be of value in this connection and afford a new method for the approach of this subject. This instrument is merely a soft rubber Nelaton catheter No. 14 or No. 15 (F) and marked in an appropriate manner. It can be inserted through the pyloric sphincter and into the duodenum in infants, from the time of birth up to the age of two years, with a facility comparable to the passage of the ordinary stomach-tube in the adult. It seems hardly necessary to outline the technic of this procedure, in view of the fact that a previous article2 describes it in detail, including radiographs which clearly demonstrate the presence of the catheter within the lumen of the upper intestine. For the purpose of bacterial investigation this duodenal catheter was sterilized and then capped at the end with a gelatin capsule, such as the apothecary frequently makes use of in dispensing drugs. This capsule had been sterilized by dry heat at 1600 C. and then, by means of sterile forceps, was slipped over the eye at the end of the catheter, and fastened by slightly moistening with

Surgical Treatment of Pyloric Stenosis, with Report of Cases

Surgical Treatment of Pyloric Stenosis, with Report of Cases

The Medical Treatment of Pyloric Stenosis

The Medical Treatment of Pyloric Stenosis

I. On the Operative Treatment of Pyloric Stenosis

I. On the Operative Treatment of Pyloric Stenosis