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Hypertrophic Pyloric Stenosis in an Adolescent Girl: An Atypical Presentation of an Unexpected Disease. Diseases 2023; 11:diseases11010019. [PMID: 36810533 PMCID: PMC9944443 DOI: 10.3390/diseases11010019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Hypertrophic pyloric stenosis is a common cause of vomiting in the first few weeks of life, but in rare cases, it may occur in older subjects with a major risk of delayed diagnosis and complications. We describe the case of a 12-year-and-8-month-old girl who presented to our department for epigastric pain, coffee-ground emesis, and melena, which arose after taking ketoprofen. An abdomen ultrasound showed thickening (1 cm) of the gastric pyloric antrum, while upper-GI endoscopy documented esophagitis and antral gastritis with a non-bleeding pyloric ulcer. During her hospital stay, she had no further episodes of vomiting and was therefore discharged with a diagnosis of "NSAIDs-induced acute upper gastrointestinal tract bleeding". After 14 days, following recurrence of abdominal pain and vomiting, she was hospitalized again. At endoscopy, pyloric sub-stenosis was found, abdominal CT showed thickening of large gastric curvature and pyloric walls, and an Rx barium study documented delayed gastric emptying. On suspicion of idiopathic hypertrophic pyloric stenosis, she underwent Heineke-Mikulicz pyloroplasty with resolution of symptoms and restoration of a regular caliber of the pylorus. Hypertrophic pyloric stenosis, although occurring rarely in older children, should be taken into account in the differential diagnosis of recurrent vomiting at any age.
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Gangemi A, Darkwa L, Carroll RE. Robotic pyloroplasty of adult idiopathic hypertrophic pyloric stenosis. Minerva Surg 2022; 77:488-490. [PMID: 36331368 DOI: 10.23736/s2724-5691.22.09501-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio Gangemi
- Division of General and Minimally Invasive Surgery, Department of Surgery, College of Medicine, University of Illinois, Chicago, IL, USA -
| | - Louis Darkwa
- College of Medicine, University of Illinois, Chicago, IL, USA
| | - Robert E Carroll
- Division of Gastroenterology, Department of Medicine, College of Medicine, University of Illinois, Chicago, IL, USA
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Iacoviello O, Verriello G, Castellaneta S, Palladino S, Wong M, Mattioli G, Giordano P, Francavilla R, Cristofori F. Case report: Late-onset hypertrophic pyloric stenosis in a 3-year-old boy: It is never too late. Front Pediatr 2022; 10:949144. [PMID: 36052362 PMCID: PMC9424671 DOI: 10.3389/fped.2022.949144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertrophic Pyloric Stenosis (HPS) represents a relatively rare occurrence beyond infancy. Here, we present the case of a barely 3-year-old boy diagnosed with late-onset HPS and successfully treated with extra-mucosal pyloromyotomy. We review the literature, challenging the principle that more aggressive surgical approaches should be preferred over less invasive ones.
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Affiliation(s)
- Onofrio Iacoviello
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Giuseppe Verriello
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Stefania Castellaneta
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Stefano Palladino
- Department of Radiology, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Michela Wong
- Department of Pediatric Surgery, Istituto "Giannina Gaslini," University of Genoa, Genoa, Italy
| | - Girolamo Mattioli
- Department of Pediatric Surgery, Istituto "Giannina Gaslini," University of Genoa, Genoa, Italy
| | - Paola Giordano
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Ruggiero Francavilla
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Fernanda Cristofori
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
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Bayramoğlu Z, Başsorgun İC, Ünal B, Akın M, Elpek GÖ. Focal pyloric hypertrophy in adults: a diagnostic pitfall-a case report and review of the literature. Clin J Gastroenterol 2020; 13:60-65. [PMID: 31346979 DOI: 10.1007/s12328-019-01025-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 02/08/2023]
Abstract
Adult hypertrophic pyloric stenosis in the form of focal pyloric hypertrophy is an uncommon but a well-established lesion. In most cases, clinical findings suggest malignancy, and despite advances in imaging techniques, preoperative diagnosis is difficult. Herein, an example of focal pyloric hypertrophy is presented with a review of the literature to emphasize the clinicopathological characteristics of this lesion. In a 43-year-old man with abdominal discomfort, endoscopy showed a 1.5 cm nodular lesion near the pylorus that necessitated surgery to exclude malignancy. Pathological examination allowed the diagnosis of focal pyloric hypertrophy. The present case and the review revealed that focal pyloric hypertrophy is a male dominant lesion in middle-aged patients. The clinical diagnosis is problematic, and its initial diagnosis depends on a high clinical suspicion in patients with upper gastrointestinal system complaints irrespective of the duration of the symptoms. It is not known whether it is a separate entity from the diffuse form. Although both are similar in a clinical point of view, etiopathogenetic studies are required to clarify their differences completely. Moreover, the rare occurrence of focal pyloric hypertrophy and the lack of diagnostic clinical findings do not exclude its consideration in the differential diagnosis, especially in patients with gastric outlet obstruction.
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Affiliation(s)
- Zeynep Bayramoğlu
- Department of Pathology, Akdeniz University Medical School, 07070, Antalya, Turkey
| | | | - Betül Ünal
- Department of Pathology, Akdeniz University Medical School, 07070, Antalya, Turkey
| | - Mete Akın
- Department of Gastroenterology, Akdeniz University Medical School, 07070, Antalya, Turkey
| | - Gülsüm Özlem Elpek
- Department of Pathology, Akdeniz University Medical School, 07070, Antalya, Turkey.
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Congenital anomalies of the gastrointestinal tract diagnosed in adulthood--diagnosis and management. J Gastrointest Surg 2010; 14:916-25. [PMID: 20033342 DOI: 10.1007/s11605-009-1124-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 11/30/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Congenital anomalies of the gastrointestinal tract are a significant cause of morbidity in children and less frequently in adults. In rare cases, they may run undetected during childhood and may present during adolescence. These abnormalities include developmental obstructive defects of the duodenum and the small intestine, anomalies of rotation and fixation, intestinal duplications, and anomalies of the colon and rectum. DISCUSSION When detected in adulthood, they may require different evaluation and surgical correction. Some of these anomalies should be managed surgically as soon as they cause symptoms. Others may cause persistent problems in adulthood requiring medical management for years. Herein, we present a comprehensive review of all the different ways of diagnosis and management of these anomalies reported in the literature.
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Kim CH, Han HS, Lee SY, Kim BK, Sung IK, Seong MK, Lee KY. Torus hyperplasia of the pyloric antrum. J Korean Med Sci 2010; 25:152-4. [PMID: 20054408 PMCID: PMC2800006 DOI: 10.3346/jkms.2010.25.1.152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 07/18/2008] [Indexed: 11/20/2022] Open
Abstract
Primary or idiopathic hypertrophy of the pyloric muscle in adult, so called torus hyperplasia, is an infrequent but an established entity. It is caused by a circular muscle hypertrophy affecting the lesser curvature near the pylorus. Since most of the lesions are difficult to differentiate from tumor, distal gastrectomy is usually preformed to rule out most causes of pyloric lesions including neoplastic ones through a pathological study. A 56-yr-old man with a family history of gastric cancer presented with abdominal discomfort of 1 month duration. Upper gastrointestinal endoscopy showed a 1.0 cm sized irregular submucosal lesion proximal to the pylorus to the distal antrum on the lesser curvature. On colonoscopy examination, a 1.5 cm sized protruding mass was noticed on the appendiceal orifice. Gastrectomy and cecectomy were done, and histological section revealed marked hypertrophy of the distal circular pyloric musculature and an appendiceal mucocele. To the best of our knowledge, this is the first case of torus hyperplasia with appendiceal mucocele which is found incidentally.
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Affiliation(s)
- Chi-Hun Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Seung Han
- Department of Pathology, Konkuk University School of Medicine, Seoul, Korea
| | - Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Kook Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - In-Kyung Sung
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Moo Kyung Seong
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Yung Lee
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
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Papaziogas B, Lazaridis C, Souparis A, Koutelidakis I, Grigoriou M, Dragoumis D, Atmatzidis K. Idiopathic hypertrophic pyloric stenosis combined with left paraduodenal hernia in an adult. Med Princ Pract 2007; 16:151-4. [PMID: 17303953 DOI: 10.1159/000098370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Accepted: 05/22/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We report a case of primary hypertrophic pyloric stenosis combined with a paraduodenal hernia in a 35-year-old woman. CLINICAL PRESENTATION AND INTERVENTION The patient presented with signs of obstructive ileus. CT of the abdomen revealed a marked dilatation of the stomach and the proximal jejunum as well as a circumferential thickening of the antral-pyloric region with characteristics indicating hypertrophic pyloric stenosis. Exploratory laparotomy revealed the presence of a paraduodenal hernia containing jejunal loops and marked thickening of the pyloric region. The jejunum was reduced to its normal place and the ostium of the paraduodenal hernia closed with a running suture. The hypertrophic pyloric stenosis was treated with pyloromyotomy. Since the patient had no predisposing factors for the development of secondary pyloric stenosis, we considered the pyloric stenosis as congenital in origin. CONCLUSION To our knowledge this is the first reported case of congenital pyloric stenosis combined with the presence of a paraduodenal hernia in an adult.
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Affiliation(s)
- Basilios Papaziogas
- 2nd Surgical Clinic, Aristotle University Hospital G. Gennimatas, Thessaloniki, Greece.
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Hellan M, Lee T, Lerner T. Diagnosis and therapy of primary hypertrophic pyloric stenosis in adults: case report and review of literature. J Gastrointest Surg 2006; 10:265-9. [PMID: 16455460 DOI: 10.1016/j.gassur.2005.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 06/01/2005] [Accepted: 06/02/2005] [Indexed: 01/31/2023]
Abstract
Adult idiopathic hypertrophic pyloric stenosis (AIHPS) is a misleading anatomic and radio-clinical entity of unknown etiology. Only about 200 cases have been reported in the literature. It is a benign disease resulting from hypertrophy of the circular fibers of the pyloric canal. Despite the recent progress in radiography and endoscopy, it is very hard to define hypertrophic stenosis in adults. Differentiation of primary from secondary pyloric stenosis is frequently a task of the pathologist rather than the surgeon. The main therapy is surgical, although endoscopic dilatation has been tried. There remains controversy over the best surgical approach. A case is reported of a 48-year-old male patient with AIHPS who was subjected to distal gastrectomy. This paper discusses the possible causes of the disorder, the recommended diagnostic steps, and the different surgical approaches.
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Affiliation(s)
- Minia Hellan
- From the Department of Surgery, Illinois Masonic Medical Center, 836 W. Wellington Avenue, Chicago, IL 60657, USA.
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