• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권3호
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• pp.196-200
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• 2014

Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제27권2호
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• pp.88-94
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• 2024

Purpose: Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal disease in neonates and hypochloremia metabolic alkalosis is a typical laboratory finding in affected patients. This study aimed to analyze the clinical characteristics of infants with IHPS and evaluate the association of clinical and laboratory parameters with ultrasonographic findings. Methods: Infants diagnosed with IHPS between January 2017 and July 2022 were retrospectively evaluated. Results: A total of 67 patients were included in the study. The mean age at diagnosis was 40.5±19.59 days, and the mean symptom duration was 11.97±9.91 days. The mean pyloric muscle thickness and pyloric canal length were 4.87±1.05 mm and 19.6±3.46 mm, respectively. Hyponatremia and metabolic alkalosis were observed in five (7.5%) and 36 (53.7%) patients, respectively. Serum sodium (p=0.011), potassium (p=0.023), and chloride levels (p=0.015) were significantly lower in patients with high bicarbonate levels (≥30 mmol/L). Furthermore, pyloric canal length was significantly higher in patients with high bicarbonate levels (p=0.015). To assess metabolic alkalosis in IHPS patients, the area under the receiver operating characteristic curve of pyloric canal length was 0.910 and the optimal cutoff value of the pyloric canal length was 23.5 mm. Conclusion: We found a close association between laboratory and ultrasonographic findings of IHPS. Clinicians should give special consideration to patients with pyloric lengths exceeding 23.5 mm and appropriate fluid rehydration should be given to these patients.

• Advances in pediatric surgery
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• 제5권1호
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• pp.64-68
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• 1999

The length, diameter and muscle thickness of the pylorus were measured by ultrasonograms in 15 infants with infantile hypertrophic pyloric stenosis(IHPS). These measurements were compared to assemble measurements of infants who came in for the routine vaccination and underwent ultrasonogram. This study also studied by ultrasound the changes in the pylorus of patients who underwent pyloromyotomy 4 weeks and 8 weeks postoperatively. According to $Carver^5$, the pyloric muscle volume(PMV) and pyloric muscle index(PMI) were calculated in each case. The pyloric muscle volume, PMI and the thickness of pyloric muscle proved to be a more reliable guide to diagnose IHPS than length and diameter of pylorus. The pyloric muscle length, diameter, thickness and pyloric muscle volume were not normalized at 4 and 8 weeks after pyloromyotomy. However, pyloric muscle index was normalized at 4 weeks postoperatively perhaps as the result of rapid weight gain after pyloromyotomy.

• 한국임상수의학회지
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• 제35권6호
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• pp.302-307
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• 2018

This report describes the unusual ultrasonography features of chronic hypertrophic pyloric gastropathy in two dogs - a 12-year-old neutered male Pekingese (case 1) and an 11-year-old spayed female Shih Tzu (case 2) - with chronic vomiting and weight loss. Chronic hypertrophic pyloric gastropathy can be observed as the focal thickening of the pyloric wall with normal layers on ultrasonography images. However, in case 1, gastric neoplasia could not be ruled out because of the presence of regional lymph node enlargement; in case 2, an intussusception was tentatively diagnosed because of a mass within the pylorus, which appeared to be connected to the descending duodenum on the longitudinal image. In both cases, focally thickened pyloric walls were demonstrated through exploratory laparotomy, and the histopathological diagnosis of chronic hypertrophic pyloric gastropathy was made. Ultrasonography is useful for imaging the gastrointestinal tract, and the typical ultrasonographic features of chronic hypertrophic pyloric gastropathy have been reported. However, the possibility, that chronic hypertrophic pyloric gastropathy can present unusual ultrasonographic findings similar to those of tumors or intussusception, should also be considered.

• Journal of Chest Surgery
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• 제53권4호
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• pp.233-241
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• 2020

Vagal damage and subsequent pyloric denervation inevitably occur during esophagectomy, potentially leading to delayed gastric emptying (DGE). The choice of an optimal pyloric procedure to overcome DGE is important, as such procedures can lead to prolonged surgery, shortening of the conduit, disruption of the blood supply, and gastric dumping/bile reflux. This study investigated various pyloric methods and analyzed comparative studies in order to determine the optimal pyloric procedure. Surgical procedures for the pylorus include pyloromyotomy, pyloroplasty, or digital fracture. Botulinum toxin injection, endoscopic balloon dilatation, and erythromycin are non-surgical procedures. The scope, technique, and effects of these procedures are changing due to advances in minimally invasive surgery and postoperative interventions. Some comparative studies have shown that pyloric procedures are helpful for DGE, while others have argued that it is difficult to reach an objective conclusion because of the variety of definitions of DGE and evaluation methods. In conclusion, recent advances in interventional technology and minimally invasive surgery have led to questions regarding the practice of pyloric procedures. However, many clinicians still perform them and they are at least somewhat effective. To provide guidance on the optimal pyloric procedure, DGE should first be defined clearly, and a large-scale study with an objective evaluation method will then be required.

• 대한한방내과학회지
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• 제30권1호
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• pp.1-8
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• 2009

Objective : The aims of this study were to observe how body weight and gastric morphology were changed and whether gastric emptying was impaired in rats with partial pyloric obstruction. and to evaluate whether electroacupuncture was able to restore delayed gastric emptying. Methods : Partial pyloric obstruction was induced by wrapping a nonabsorbable rubber ring around the 1st portion of the duodenum for 2 weeks. Body gain and morphologic changes of stomach were investigated and compared with normal intact rats. Gastric emptying was measured by numbering expelled glass of beads in rats. Rats were divided into 4 groups(non-acupuncture, manual acupuncture. 3Hz-electroacupuncture. 60Hz-electroacupuncture). Stimulus intensity in two electroacupuncture groups was 1.2 times of pain threshold. Results : Partial pyloric obstruction produced a significant loss of body weight and induced a significant increase of gastric surface area. The 60Hz electroacupuncture-stimulated group significantly restored the delayed gastric emptying compared to the other groups of rats with partial pyloric obstruction. Conclusion : 60Hz electroacupuncture stimulation on Zusanli(ST36) showed significant restoration of delayed gastric emptying in rats with partial pyloric obstruction.

• 대한한방내과학회지
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• 제33권1호
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• pp.26-38
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• 2012

Objectives : The aim of this study was to investigate the effect of partial pyloric obstruction on body weight, gastric juice, gastric surface area and gastric edema in normal intact and/or vagotomized rats. Methods : Partial pyloric obstruction was performed by wrapping a non-absorbable rubber ring (D:6 mm, W:4 mm, T:1 mm) around the 1st portion of the duodenum. Vagotomy was performed by resecting the branches around the esophagogastric junction. Pre-post body weight differential, fasting gastric juice volume, gastric surface area and gastric edema were measured at 8 weeks and 20 weeks. For the effect of pyloric reperfusion the rubber ring was removed after 8 weeks and then an additional 12 weeks of observation was performed to the end of the 20-week experimental period. Results : In the initial 8 weeks observation, the effect of pylorus obstruction and/or vagotomy was significantly remarkable in the pylorus obstructed and vagotomized group; slowdown of weight gain, increase of fasting gastric juice volume, dilatation of gastric surface area and severe gastric edema were shown. In the remaining 12 weeks observation, the effect of reperfusion was significantly remarkable in the ring-removed antral dilated group; recovery of weight gain, decrease of gastric surface area and decrease of gastric edema were shown. However, gastric juice volume was not significantly different from the other group. Conclusions : Partial pyloric obstruction plays a aggravating role and the vagus nerve plays a protective role in body weight, gastric juice, gastric surface area, and gastric edema. Furthermore, pyloric valve dysfunction as an aggravating factor strengthened in defect of the vagus nerve. These results suggest that patients with both functional pyloric outlet obstruction and hypofunction of vagus nerve need to be diagnosed in good time and treated properly.

• 대한수의학회지
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• 제31권1호
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• pp.19-26
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• 1991

한국산 고슴도치의 위점막에 분포하는 내분비세포에 대해 면역조직화학적으로 관찰하였던바, gastrin, somatostatin, 5-HT, glucagon, BPP, motilin, GIP 등 7종의 면역반응세포들이 동정되었으며, 이들 세포들의 부위별 분포와 출현빈도의 특정은 다음과 같다. Gastrin 면역반웅세포는 유문부에서만 아주 다수로 출현하였으며, somatostatin 면역반응세포는 유문부에서 다수, 분문부와 위저부에서는 중등도의 출현올 볼 수 있었다. 5-HT 면역반응세포는 분문부와 유문부에서 다수, 위저부에서는 중등도로 출현하였다. glucagon 면역반응세포는 위저부에서 소수로 그리고 유문부에서 극히 소수로 출현하였고, BPP 면역반응세포는 유문부에 다수로, 위저부에 중등도로 분문부에 소수로 분포하였다. motilin 면역반응세포는 유문부와 위저부에서 소수 또는 극소수로 출현하였으며, GIP 면역반응세포는 유문부에서만 소수의 분포를 볼 수 있었다.

• Advances in pediatric surgery
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• 제3권1호
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• pp.77-82
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• 1997

The association of pyloric atresia and epidermolysis bullosa(EB) in newborn is rare and inheritant as an autosomal recessive trait. We report a newborn girl with pyloric atresia and epidermolysis bullosa. Blisters were noted on her skin at birth, especially in pressure-exposed area, and later on the oral mucosa. Junctional epidermolysis bullosa was confirmed by light microscopy and electron microscopy. Radiography revealed pyloric atresia. Segmental resection of 1.5 cm and gastroduodenostomy were carried out at 4 days of age. Protein loosing enteropathy developed after oral feeding. The frequency of episodes of nonscarred blisters and the severity and duration improved significantly with time. The protein loosing enteropathy was persistent, and at 1 year of age, her growth is markedly retarded.

• Animal cells and systems
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• 제6권3호
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• pp.247-252
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• 2002

The effect of paraquat (PQ, 1,1＇-dimethyl-4,4＇-bipyridium) on the histogene-sis and glycoconjugates (GCs) properties of the pyloric region of the stomach in a perinatal rat was examined by histological and histochemical methods. Oral administration of PQ (9 mg/kg per day in 0.2 mL of D.W.) on 7 to 14 days of gestation revealed growth retardation with significant reductions in the length of pyloric gland and their pit. As for histochemical properties of GCs in the pyloric region of the stomach, the PQ-treated rats showed some differences, such as delayed initial appearance of the sulfated GCs and lectin affinities compared with the vehicle group. These different GCs properties in the surface and gastric pit were usually detected in the fetal rats and more prominent and evident differences were revealed in the gland epithelium of the early postnatal rat. These results suggest that maternal PQ administration causes intrauterine growth retardation asso-ciated with delayed histogenesis and GCs immaturation of pyloric mucosa in developing rat.