Adult hypertrophic pyloric stenosis that improved by spontaneous double channel pylorus formation

Abstract

Adult hypertrophic pyloric stenosis (AHPS) is a rare disease and presents as pyloric obstruction. Double pylorus is also a rare condition due to a gastroduodenal fistula connecting from the gastric antrum to the duodenum. A 42‐year‐old woman without a history of vomiting in infancy presented with postprandial abdominal distension and repeated vomiting. Abdominal computed tomography showed gastric dilatation and wall thickening of the distal stomach. Endoscopy and contrast gastrography revealed gastric outlet obstruction due to stenosis and an ulcer in the antral and pyloric region. Endoscopic ultrasonography revealed circumferential thickening of the muscularis propria layer of the pylorus. Her symptoms improved with treatment consisting of drainage, fasting, and a proton pump inhibitor. Two weeks after onset, follow‐up endoscopy revealed a healing ulcer and double channel pylorus. Based on her clinical course and findings of clinical images, she was diagnosed with gastric outlet obstruction due to AHPS that was improved by double channel pylorus formation. In conclusion, AHPS that was improved by double channel pylorus formation is an extremely rare condition, and we should be aware of this disease entity.

Gastric outlet obstruction secondary to adult hypertrophic pyloric stenosis: case report and literature review

“…The clinical symptoms of idiopathic AHPS are like the clinical symptoms of gastric outlet obstruction induced by other causes including epigastralgia, early satiety, and postprandial nausea or vomiting. 1,[4][5][6]10 The exact etiology of AHPS is unclear, and it is usually difficult to diagnose AHPS before surgical resection.…”

“…5 In patients with AHPS, gastrography usually shows an elongated and narrow pyloric canal and delayed gastric emptying due to pyloric stenosis. 1 While abdominal tomography often shows thickening of the distal gastric wall. 2,6 Endoscopic ultrasound is diagnostic of AHPS when the pyloric muscle wall is greater than 10 mm, the wall of a normal pyloric muscle varies from 3.8 to 8 mm.…”

“…2,6 Endoscopic ultrasound is diagnostic of AHPS when the pyloric muscle wall is greater than 10 mm, the wall of a normal pyloric muscle varies from 3.8 to 8 mm. 1,2 Measurements of up to 3 cm have been recorded in AHPS. 6 In AHPS gastroscopy secondary gastric ulcers, the mucosa of the gastric sinus or pyloric hilum shows obvious ulcerative erosion, mucosal thickening around the ulcerated surface, loss of the pyloric duct, and local ulceration.…”

“…Adult hypertrophic pyloric stenosis (AHPS) is a rare entity and presents as a pyloric obstruction secondary to hypertrophy of the circular fibers of the pyloric canal. 1 There are various classifications, however the most common type of AHPS is secondary to underlying gastrointestinal pathologies, such as peptic ulcer, malignant tumors, and certain inflammatory diseases. 2 Chronic peptic ulcer resulting in gastric outlet obstruction is the least common complication, occurring in approximately 2 percent of cases.…”