Adult hypertrophic pyloric stenosis

Introduction to adult hypertrophic pyloric stenosis Adult hypertrophic pyloric stenosis (adulthypertrophic pyloricosis) is a pyloric stenosis caused by pyloric ring muscle hypertrophy, and is associated with congenital hypertrophic pyloric stenosis. basic knowledge The proportion of disease: 0.04%-0.05% (the rate of gastric ulcer is significantly increased, about 0.04%-0.05%) Susceptible people: no specific people Mode of infection: non-infectious Complications: pyloric obstruction, gastric ulcer

Causes of adult hypertrophic pyloric stenosis

(1) Causes of the disease

The cause of adult hypertrophic pyloric stenosis is not very clear. It is generally divided into two categories, primary and secondary. Most cases reported in the first half of the 20th century are secondary, mainly accompanied by gastric ulcer, twelve fingers. Intestinal ampullary ulcer, history of cancer or postoperative adhesions and gastroliths, and local inflammation, ulcers, etc., cause the pyloric sphincter to be in a state of paralysis for a long time. Some people think that this disease is a continuation of hypertrophic stenosis in infants, with postnatal vomiting and surgical history. 20%, the origin is very rare, mostly the continuation of congenital hypertrophic pyloric stenosis, no obvious gastrointestinal symptoms after birth, often manifested in adulthood, but there have been cases reported in a family can show There are both childhood and adult onset, 80% of cases are male patients, the age of onset varies greatly, and the rate of conventional gastro-intestinal angiography in some cases is only 0.04% to 1%.

(two) pathogenesis

Pathological changes showed that the pyloric muscle layer was obviously thicker than 2 ~ 4cm, the fat was ring-shaped or fusiform, the ring muscle muscle fiber hypertrophy was irregularly arranged, the mucosa and submucosal tissue edema could be accompanied by inflammatory changes, and some cases of local hyperplasia fiber connective Organized by alternative hyperplasia.

Adult hypertrophic pyloric stenosis prevention

If it is caused by secondary sexually transmitted diseases, such as local inflammation of the stomach, ulcers, etc., it is especially important to prevent the primary disease.

Adult hypertrophic pyloric stenosis complications Complications pyloric obstruction gastric ulcer

There may be pyloric obstruction, gastric ulcer, mucosal erosion, bleeding, cancer and other complications.

Adult hypertrophic pyloric stenosis symptoms Common symptoms Indigestion pyloric muscle hypertrophy Upper abdominal discomfort pyloric area ulcer

There are 3 types:

1. There is a feeling of discomfort in the upper abdomen. There is periodic vomiting from infancy, that is, from intermittent pyloric dysfunction in infants and children until adulthood, but some primary cases have no history of repeated vomiting in infancy.

2. The symptoms of upper abdominal discomfort and dyspepsia begin to appear in adulthood. Aggravation of pain and vomiting after eating are common symptoms.

3. From the middle age to the old age, the symptoms of pyloric obstruction appear. The history of ulcer is short, but it is progressive, and may be accompanied by hemorrhage. After detailed examination, only the pyloric muscle hypertrophy was found in the operation.

The clinical symptoms are related to the degree of pyloric stenosis and the length of the disease. It can also be asymptomatic. Symptoms usually appear in adulthood. It is manifested as a feeling of fullness and discomfort in the upper abdomen after meals or vomiting after meals. After vomiting, the upper abdomen is relieved and intermittent. Attack, anterior pyloric ulcer often complicated by the above symptoms, rare signs, rarely touch the hypertrophic pyloric canal, severe cases may have signs of pyloric obstruction.

Adult hypertrophic pyloric stenosis

Histological examination can confirm the diagnosis.

Gastroscope and X-ray barium meal are commonly used examination methods. Gastroscopy shows gastritis changes, anterior pyloric ulcer. When there is obstruction, the pylorus is obviously narrow and the edge is smooth. X-ray barium meal angiography shows that the pyloric tube is long and narrow, and one or both sides of the middle segment are small. The triangular bag-like bulge can disappear after partial compression. The mucosal folds of the lumen are generally arranged in a longitudinal direction, sometimes curved and irregular, and the crescent of the duodenum has a crescent-shaped dent, which is a part of the hypertrophic pylorus. Because of the nesting.

Diagnosis and differentiation of adult hypertrophic pyloric stenosis

The diagnosis of this disease is more difficult, such as clinical manifestations of this disease should be further examined to clear, gastric retention often increased, gastric acid secretion is more normal, gastroscopy and X-ray barium meal can help diagnosis, confirmed by pathological histological examination.

The disease needs to be differentiated from pyloric fistula, duodenal obstruction, achalasia, gastric torsion and other non-obstructive vomiting.

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