Pyloric stenosis secondary to peptic ulcer disease in pediatric patients: A case report and review of the literature

Abstract

Rationale: Pediatric pyloric obstruction is a condition characterized by complete or incomplete obstruction of the distal stomach caused by obstructive lesions of the distal stomach, pyloric duct, or proximal duodenum. Congenital hypertrophic pyloric stenosis is the most common cause of pediatric pyloric obstruction, whereas acquired pyloric stenosis is comparatively rare, with peptic ulcer disease being the most common cause. Patient concerns: We describe a case of a 5-year-old girl who had peptic ulcer disease and developed scarring pyloric stenosis. We also give comprehensive details of the diagnosis and course of treatment. Diagnosis: Intraoperative findings revealed ulcerative, scarring pyloric obstruction. Interventions: Conservative treatment failed and surgery was subsequently performed. Outcomes: No further vomiting symptoms occurred after surgery. And 3 months after surgery, the patient had gained weight on average and had no further complaints. Lessons: Although scarring pediatric pyloric blockage due to peptic ulcer is less common, emphasis should be placed on rapid diagnosis by accurate gastroscopy, barium meal of the gastrointestinal tract, or ultrasonography. Depending on the patient’s condition, conservative treatment or surgery should be chosen carefully selected.

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.…”

“…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. 4 The classic finding on gastroscopy is a fixed, markedly narrowed pylorus with a smooth edge. 7 The histopathological result of idiopathic AHPS shows a very elongated and thickened pylorus.…”

“…2,6 The histopathological result of secondary AHPS gastric ulcers shows persistent infiltration of inflammatory cells and hyperplasia of scar tissue in the pyloric mucosa and submucosa. 4 Most authors agree that histological confirmation of the disease is recommended to safely rule out malignancy. 7 Asymptomatic patients or patients with minimal symptoms do not require treatment while patients with clinical evidence require surgical treatment.…”

“…3 Patients with secondary AHPS often do not present any symptoms. 4 Diagnosing hypertrophic stenosis in adults remains a challenge; differentiation between primary and secondary pyloric stenosis is made by histopathological report. The main treatment is surgical, although endoscopic dilation can also be performed.…”

“…However, there is still no consensus on what the best surgical approach is. 4 A rare case of hypertrophic pyloric stenosis is presented in an adult patient secondary to acid peptic disease, which presents with gastric outlet obstruction, successfully treated surgically. This article discusses the various etiologies of AHPS, diagnostic methods, and possible surgical treatments.…”