On the Roentgen‐anatomical Appearance of Congenital Pyloric Stenosis during and after the Manifest Stage of the Disease

Abstract

Summary. Pyloric stenosis in infants has a typical roentgen‐anatomical appearence. In the manifest stage the canalis egestorius is contracted to a narrow, streak‐like lumen, 2—3 cm in length. The stomach shows stenosal peristalsis, which does not pass beyond the oral limit of the constriction. The duodenal cap is normal in shape and size. The opening time of the stomach is prolonged up to 2 hours (Stage I). After the cessation of the manifest symptoms up to 4 years the opening time is normal and the lumen of the canalis egestorius is somewhat wider with longitudinal rugae Stage II. Later up to 13 years the condition is otherwise unchanged with the exception of the occurrence in some cases of slight peristaltic‐like waves along the canalis egestorius (Stage III). In other cases the canalis egestorius is of normal width and shows normal peristalsis. A clinically symptom‐free member of a pair of twins, the other member with a typical pyloric stenosis, Stage I, showed the roentgen‐anatomical picture of Stage II. The anatomical change consists partly of a thickening of the muscularis propria and partly of the mucosa. In Stages I and II the muscularis propria is unchanged, in Stage III it shows an incipient peristalsis. In Stage I the mucosa almost entirely fills the lumen – manifest symptoms and prolonged opening time. In Stages II and III the swelling of the mucosa is decreased with a canalisation of the lumen and disappearance of the symptoms. The change may be limited to Stage II without any clinical symptoms.

Radiographic Follow‐Up in Hypertrophic Pyloric Stenosis1

“…Similar findings have been demonstrated by Runstrom (1939), in a radiographic follow-up of medically treated patients. Runstrom is, however, of the opinion that the abnormalities disappear in all patients about the age of puberty.…”

Hypertrophic pyloric stenosis: adult and congenital types occurring in the same family.

“…as suggested by McConnell (1966), the adult disease is not severe enough to give obstructing symptoms in infancy. Runstrom (1939) and…”

Simple and complicated hypertrophic pyloric stenosis in the adult

“…Runstrom (1939) studied 107 children with congenital pyloric stenosis treated medically and showed that the radiological abnormalities became less frequent with advancing years, but were still present long after there were no symptoms. Lumsden and Truelove (1958), in 17 patients between the ages of 14 and 25 years, confirmed this and showed that the fading-out process continued into full adult life.…”

“…It is hard to explain the long gap between birth and the onset of symptoms in some patients or why the hypertrophy might worsen later in life. A complicating factor, such as mucosal oedema (Runstrom, 1939), may precipitate the symptoms of pyloric occlusion. It is probably relevant to note, therefore, that complicated adult hypertrophy is more common than the simple variety, and that usually the duration of symptoms is shorter.…”