Acquired non hypertrophic pyloric stenosis in children] |
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| Authors: | F Hameury J Mcheik H Lardy J Gaudin T Petit P Ravasse M Robert C Maurage G Levard |
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| Affiliation: | 1. Département médicochirurgical de pédiatrie, hôpital J.-Bernard, CHU de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers cedex, France;2. Service de chirurgie infantile, hôpital de Clocheville, CHU de Tours, 49, boulevard Béranger, 37044 Tours cedex 01, France;3. Service de chirurgie infantile, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France;1. Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland;2. Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland;3. Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland;1. Department of Biochemistry, Post Graduate Institute of Medical Sciences, Rohtak, India;2. Department of Respiratory Medicine, Post Graduate Institute of Medical Sciences, Rohtak and J L N Medical College, Ajmer, Rajasthan, India;1. Biomedical Department of Internal and Specialist Medicine (DIBIMIS), Division of Medicine, Villa Sofia-V. Cervello Hospital, Palermo University, Palermo, Italy;2. Institute of Pathology “Villa Sofia-V. Cervello Hospital”, Palermo University, Palermo, Italy;1. State Key Lab of Superhard Materials, Jilin University, Changchun 130012, PR China;2. College of Chemistry, Jilin University, Changchun 130012, PR China |
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| Abstract: | Pediatric non hypertrophic pyloric stenosis (NHPS) are uncommon. Their causes and treatments are debated.Material and methodRetrospective review of all cases of NHPS from 3 pediatric surgery services during the period 1984–2002.ResultsSix children, aged 17 months to 15 years, underwent surgery for NHPS. Clinical symptoms, food vomiting and loss of weight, were present for several weeks before the diagnosis of NHPS was made. The diagnosis was peptic stenosis in 3 cases and has not been established in 3 cases. Search for Helicobacter pylori was negative in all cases. Failure of specific medical treatment and endoscopic dilatations led to pyloric resection in 3 cases and pyloroplasty in 3 cases. Post operative course was uneventful with normal oral feeding and normalisation of weight status. Histologic data were aspecific. No recurrence was observed.DiscussionWe discuss the origin of the pyloric stenosis, regarding clinical, operative and pathological data: were the stenosis the cause or consequence of peptic ulcer? Peptic disease is always advocated, but difficult to prove and may be excessively incriminated. Late symptomatic congenital and acquired idiopathic pyloric stenosis should be recalled. In all cases of proved pyloric stenosis, after failure of medical and endoscopic treatment, a simple surgical procedure (pyloroplasty) associated with medical treatment seems to be effective.ConclusionThe diagnosis of NHPS should be suspected in a child with food vomiting and loss of weight if his age is not concordant with hypertrophic pyloric stenosis. Upper gastro-intestinal series and endoscopy are diagnostic. The precise cause of the stenosis is more difficult to asses. When the medical treatment fails, a pyloroplasty is usually curative. |
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