Go to chapter: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39
Chapter 21 (page 95)
Congenital anomalies of the pyloric region of the stomach are rare (Thompson et al. l968;
Lamesch and Schneider l973; Korber and Glasson l977). The cause is usually thought to
be localized vascular impairment occurring during foetal life (Bremer l944; Louw l959).
Almost all cases of gastric atresia occur in the pyloric region (Franken l982). The
condition may present as a membrane occluding the lumen, as a gap in continuity, or a
fibrous cord intervening between patent portions at the gastroduodenal junction. Some
cases have been associated with epidermolysis bullosa (Korber and Glasson l977;
Franken l982). Clinically the condition presents as upper abdominal distension in a
newborn infant, with bile-free vomiting from birth (Davis and Douglas l961; Thompson
et al. l968; Bronsther et al. l97l). Maternal hydramnios occurs in approximately 50
percent of cases (Thompson et al. l968; Bronsther et al. l97l).
Radiographic examination shows the stomach to be distended, with complete absence of
gas in the remainder of the gastrointestinal tract. In the erect abdominal film this gives
rise to a single air-fluid level in the stomach, topped by a gas bubble (the "single bubble"
sign) (Davis & Douglas l961; Becker et al. l963; Bronsther et al. l97l). According to
Franken (l982) neonatal gastric hypotonia, which is a much more frequent condition, may
give a similar appearance. (In hypotonia gastric inactivity with lack of peristalsis and
cyclical contraction of the pyloric sphincteric cylinder may delay gastric emptying as
described in Chapter l9).
Gastric atresia usually affects the region of the pyloric sphincteric cylinder; whether it is
limited to the cylinder is not known.
- Becker JM, Schneider KM, Fischer AE. Pyloric atresia. Arch Surg
l963, 87, 413-416.
- Bremer JL. Diverticula and duplications of the intestinal tract. Arch
Path l944, 38, 132-140.
- Bronsther B, Nadeau MR, Abrams MW. Congenital pyloric atresia: a report of
three cases and a review of the literature. Surgery l97l, 69, 130-136.
- Davis DA, Douglas KR. Congenital pyloric atresia, a rare anomaly. Ann
Surg l96l, 153, 418-422.
- Franken EA. Gastrointestinal Imaging in Pediatrics. Harper and
Row, Philadelphia l982, 2nd ed, p 138.
- Korber JS, Glasson MJ. Pyloric atresia associated with epidermolysis bullosa.
J Pediatr l977, 90, 600-601.
- Lamesch A, Schneider H. Atrésie et sténose congenitales du pylore. Acta
Paed Belgica l973, 27, 169-183.
- Louw JH. Congenital intestinal atresia and stenosis in the newborn; observations
on its pathogenesis and treatment. Ann Roy Coll Surg l959, 25, 209-
- Thompson NW, Parker W, Schwartz S, et al. Congenital pyloric atresia.
Arch Surg l968, 97, 792-796.
Previous Page | Table of Contents | Next Page
© Copyright PLiG 1998