Sharma KK, Ranka P, Goyal P, Dabi DR. Gastric outlet obstruction in children: an overview with report of Jodhpur disease and Sharma's classification.
J Pediatr Surg 2008;
43:1891-7. [PMID:
18926227 DOI:
10.1016/j.jpedsurg.2008.07.001]
[Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 07/04/2008] [Accepted: 07/04/2008] [Indexed: 01/05/2023]
Abstract
BACKGROUND/PURPOSE
Gastric outlet obstruction (GOO) is overwhelmingly described as infantile hypertrophic pyloric stenosis that overshadows other causes; thereby, there is a need to develop an elaborate and comprehensive classification. We present the same and establish a new disease called primary acquired gastric outlet obstruction during infancy and childhood that was reported for the first time by us in 1997, reviewing the literature published since then, with report of our new cases.
METHODS
Eight patients of this disease presented at our center from 1996 to May 2008, and these were analyzed epidemiologically and clinically. Other reports published in literature were compared, and all reported patients were compiled.
RESULTS
All 8 cases presented at age ranging from 1 month to 6 years, with mean age of 2.9 years; there was predilection for male sex (male, 7; female, 1). Presenting symptoms and signs were nonbilious vomiting, weight loss, dehydration, dyselectrolytemia, abdominal pain, and visible gastric peristalsis. Upper gastrointestinal contrast study showed large stomach and increased gastric emptying time. Endoscopy displayed normal stomach without intraluminal lesion. Exploration revealed a dilated stomach, without any pyloric muscular hypertrophy, scarring, inflammation, or obstruction externally or intraluminally. Result of histopathologic examination was normal. All patients except 1 (died of unrelated cause) were cured by Heineke-Mikulicz pyloroplasty.
CONCLUSIONS
These patients represent a new disease entity designated as primary acquired gastric outlet obstruction during infancy and childhood. Author's classification is complete and scientific, encompassing all rare causes of GOO. We nickname this idiopathic variety of GOO the Jodhpur disease, the place of the first cases.
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