Primary hypertrophic pyloric stenosis in the adult

A case is reported of a 55 year old male patient with primary hypertrophic pyloric stenosis who was subjected to distal gastrectomy. Adult hypertrophic pyloric stenosis is an uncommon condition which is usually misdiagnosed as carcinoma of the antrum. It is a benign disease resulting from hypertrophy of the circular fibres of the pyloric canal and is recognizable radiologically by narrowing and elongation of the pyloric canal and endoscopically by appearances resembling those of the cervix. This condition is probably congenital although aetiology has not been established. In the absence of symptoms, no clinical treatment is required. However, surgical intervention is advocated, when stenosis gives rise to symptoms, there is a suspicion of malignancy, or the ulceration due to the disease. Distal gastrectomy with gastroduodenostomy is the treatment of choice.     

Multinodular adult hypertrophic pyloric stenosis

A case of multinodular hypertrophic pyloric stenosis is described in a 57-year-old woman. Over a 3-month interval, there was progressive enlargement of several mucosal nodules overlying hypertrophied muscularis, and one nodule obstructed the pyloric opening. Diagnosis was made at operation and symptoms resolved after Billroth I gastrectomy.     

Infantile hypertrophic pyloric stenosis.

This is a world-wide disease, more common in Caucasians and probably on the increase. The aetiology remains very poorly understood. Presentation is between 2 and 8 weeks with vomiting, classically projectile, in an otherwise well hungry child. The diagnosis can confidently be made in most cases by a careful test feed; ultrasound and barium meal examinations are only required for difficult cases. Intravenous fluid replacement is essential prior to surgery and 24 h or longer may be required to correct acid base disturbances and enable safe general anaesthesia. Pyloromyotomy (Ramstedt's operation) remains the only satisfactory treatment, our mortality rate for this is 0.4%. Occasional vomits occur postoperatively in over half of patients but we are sceptical of the value of graded postoperative feeding regimens. There are no known long-term sequelae to surgery and this remains a most rewarding paediatric surgical condition to treat.     

Imaging diagnosis of infantile hypertrophic pyloric stenosis: report of a case and review of the literature

Infantile hypertrophic pyloric stenosis (IHPS) is familiar to most pediatric and general practitioners, it is a pathology where the radiologist nowadays has a key role confirming the clinical suspicion based in ultrasound and upper-gastrointestinal barium examinations. There is hypertrophy and hyperplasia of the antropyloric portion of the stomach, which becomes abnormally thickened, it manifests as obstruction to gastric emptying. Infants with IHPS are clinically normal at birth, but they develop a nonbilious forceful vomiting during the first weeks of postnatal life, which is described as "projectile". Surgical treatment is curative. The clinical diagnosis hinges on palpation of the thickened pylorus. Imaging findings include the "string sign" (elongation of the pyloric canal) and the "double-track sign" (presence of linear tracts of contrast material separated by the intervening mucosa) on fluoroscopic observation. Sonographic examination demonstrates the thickened prepyloric antrum bridging the duodenal bulb and distended stomach. We present the case of a 26-days-old infant with IHPS; presenting this case we make a brief review of the clinical features and main imaging findings of IHPS.     

Advances in infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is a common condition in infancy, characterized by an acquired narrowing of the pylorus, which requires surgery. These infants usually present with projectile, nonbilious vomiting, with a palpable ‘olive’ in the abdomen and sometimes a ‘peristaltic wave’ after being fed with formula or breast milk. Although IHPS is a common disorder, its etiology is largely unknown. Surgical intervention is the standard treatment, preoperative preparation, however is essential to optimal outcome. In this review, the latest advances in IHPS regarding epidemiology, etiology, diagnostics and treatment will be discussed.     

Video capsule endoscopy and CT enterography in diagnosing adult hypertrophic pyloric stenosis

Primary adult hypertrophic pyloric stenosis is a rare but important cause of gastric outlet obstruction that may be misdiagnosed as idiopathic gastroparesis.Clinically,patients present with early satiety,abdominal fullness,nausea,epigastric discomfort and eructation.Permanent gastric retention of a video capsule endoscope is diagnostic in differentiating between the two diseases,in the absence of an organic gastric outlet obstruction.This case presents the longest video capsule retention in the medical literature to date.It is also the first case report of adult hypertrophic pyloric stenosis diagnosed with video capsule endoscopy or a computed tomography scan.Finally,an unusual"plugging"of the gastric outlet with free floating capsule has an augmented effect on disease physiology and on patient’s symptoms.     

原发性肥大性骨关节病(附一例报告)

目的 提高对原发性肥大性骨关节病的认识。方法 报告１例原发性肥大性骨关节病的临床表现、实验室检查、Ｘ线改变及皮肤透射电镜改变,并复习文献。结果 总结原发性肥大性骨关节病的病理生理改变、临床特点、诊断标准、治疗手段及预后。结论原发性肥大性骨关节病为一种自限性疾病,其临床表现呈多样性,与诊断及分型相关的临床表现为骨膜成骨亢进、杵状指（趾）、面部肥厚及脑回样头皮,诊断成立尚需排除继发性因素。血流变学改变     

Primary hypertrophic osteoarthropathy (pachydermoperiostosis): a case report

Hypertrophic osteoarthropathy is characterized by digital clubbing and periosteal reaction of long bones. Most cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia, and gastrointestinal polyps. We report a 19-year-old man presenting wıth arthritis, broadening of the fingers and clubbing of the fingers and toes for the previous 3 years. The ankles and knees were swollen. X-rays showed periosteal apposition. The search for a secondary cause remained negative. In cases of arthralgia/arthritis together with clubbed fingers, consideration must be given to hypertrophic osteoarthropathy. The primary or idiopathic form is rare and has a good prognosis.     

婴儿先天性肥厚性幽门狭窄临床特征

目的探讨婴儿先天性肥厚性幽门狭窄(congenital hypertrophic pyloric stenosis,CHPS)的临床发病特点,为该病诊治及流行病学调查提供依据。方法对307例CHPS住院患儿的病历资料进行回顾性总结和分析,观察项目包括患儿性别、发病年龄、体重变化、入院时电解质及动脉血气、B超检查结果及合并其他先天性疾病情况。将发病10d内治疗者列为早期组,超过10d者列为晚期组,比较这两组动脉血气、电解质及日平均体重增加的差别。结果 307例患儿中男性262例,女性45例,发病年龄1～351d,去掉离散程度较大者6例,其余301例平均发病年龄(23.8±13.0)d。患儿出生体重(3.24±0.44)kg(1.6～4.5kg);合并其他先天性疾病62例(20.2%)。幽门环肌B超厚度为(5.4±1.1)mm(3～8mm)。早期组日平均体重增加明显大于晚期组,而低钾血症、低氯血症及高碳酸血症发生率明显低于晚期组(P0.05);血钠与血pH值无显著性差异。结论婴儿CHPS以男性为主,发病年龄为3～5周,幽门环肌厚度(5.4±1.1)mm,合并其他先天性疾病比例较高。对于在出生后3～5周内出现持续性呕吐患儿,应高度警惕CHPS,并应尽快诊治,以减少低氯低钾性碱中毒的发生;避免病情进一步恶化。