The Size of the Pyloroduodenal Canal: Its Relation to the Cause and Treatment of Peptic Ulcer

Rm, Kirk

doi:10.1177/003591577006300936

Cited by 9 publications

(2 citation statements)

References 8 publications

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“…The relationship between ulceration and retention has been known for at least 15 years (5). The observations at this hospital also indicate that probably in many cases where medicinal treatment of ulcer is without effect a vicious circle is present.…”

Section: Discussionmentioning

confidence: 53%

Balloon Dilatation of Alimentary Tract Strictures

Hegedüs¹,

Poulsen²

1986

Acta Radiologica. Diagnosis

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From a series of balloon dilatations of alimentary tract strictures 11 patients with different types of gastric and oesophagogastric anastomotic stenoses are reported. The dilatation of gastric outflow tract obstructions was highly effective in the treatment of retention. In 7 out of 8 cases with gastric outflow stenosis surgery could be entirely avoided and replaced by balloon dilatation. The importance of eliminating retention in the healing of gastric ulcer is discussed. Fistulation in oesophagogastric anastomoses due to stenosis of the outflow portion was successfully treated. The importance of achieving a free outflow tract in order to prevent insufficiency of the anastomosis and formation of a fistula is stressed.

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Section: Discussionmentioning

confidence: 53%

Balloon Dilatation of Alimentary Tract Strictures

Hegedüs¹,

Poulsen²

1986

Acta Radiologica. Diagnosis

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“…Patients were judged to have pyloric stenosis on the basis of a history of repeated vomiting, the presence of a succussion splash, evidence of gastric retention on barium meal examination, and the operative finding that the pylorus would not admit the index finger-we found, as did Kirk (1970), that a normal pylorus will admit the distal interphalangeal joint of the index finger, which is roughly equivalent to a No. 14 Hegar dilator.…”

Section: Patientsmentioning

confidence: 76%

Highly selective vagotomy plus dilatation of the stenosis compared with truncal vagotomy and drainage in the treatment of pyloric stenosis secondary to duodenal ulceration.

McMahon¹,

Greenall²,

Johnston³

et al. 1976

Gut

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SUMMARY Twenty-three consecutive patients with duodenal ulceration complicated by pyloric stenosis who came under the care of one surgeon were treated by highly selective vagotomy (HSV) combined with digital dilatation ofthe stenosis through a gastrotomy. No form of drainage procedure was used. Thus the antral 'mill' and the pyloric sphincter were left intact. Since the stenosis is usually distal to the pylorus rather than truly pyloric such dilatation does not damage the pyloric ring, although it may on occasion lead to perforation of the first part of the duodenum. The subsequent progress of these patients was compared with that of a similar, consecutive series of 23 patients with pyloric stenosis who were treated by truncal vagotomy with a drainage procedure by other surgeons on the same surgical unit. Patients were followed up for between four months and five years. The clinical assessment was carried out in 'blind' fashion at a special gastric follow-up clinic. No evidence of recurrent ulceration was found in either group of patients. Two patients from each group subsequently came to reoperation for the relief of gastric stasis. Twenty-two of the 23 patients (96%) who had undergone HSV plus dilatation eventually achieved a good-to-excellent clinical result (Visick grades 1 + 2), whereas only 17 of the 23 patients (74 %) who had undergone truncal vagotomy with drainage achieved such a result. The main clinical difference between the two groups was that side effects such as diarrhoea and abdominal pain or discomfort were more common after vagotomy with drainage than after HSV. These results bear witness to the remarkable propulsive powers of the gastric antrum after HSV, which were evidently sufficient to overcome any tendency to re-stenosis in more than 90 % of patients. The 9 % incidence of failure due to re-stenosis could perhaps be avoided if a small duodenoplasty were performed instead of simple digital dilatation. The results support the hypothesis that damage to the antral mill and pyloric sphincter can be avoided in the course of operations for 'pyloric' stenosis secondary to duodenal ulceration. Avoidance of the drainage procedure is of benefit to the patient, just as it is in patients who have duodenal ulceration without stenosis.When pyloric stenosis is secondary to duodenal stenosis develops, the stomach compensates for the ulceration the adjective 'pyloric' is not quite accurate, obstruction at its outlet by means of hypertrophy of because in most patients the actual site of narrow-its muscular wall and by forceful peristalsis in the ing is beyond the pylorus in the first part of the antrum. Eventually, as stenosis becomes increasingly duodenum. This distinction is important, because it severe, the stomach gives up the unequal struggle, means that the pyloric sphincter and the antral mill becoming dilated and atonic. remain undamaged by the fibrosis, oedema, and Although truncal vagotomy with a drainage spasm which combine to create the stenosis. As procedure

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Ulcus-Komplikationen: Stenose

Troidl

1994

Deutsche Gesellschaft Für Chirurgie

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The Size of the Pyloroduodenal Canal: Its Relation to the Cause and Treatment of Peptic Ulcer

Cited by 9 publications

References 8 publications

Balloon Dilatation of Alimentary Tract Strictures

Balloon Dilatation of Alimentary Tract Strictures

Highly selective vagotomy plus dilatation of the stenosis compared with truncal vagotomy and drainage in the treatment of pyloric stenosis secondary to duodenal ulceration.

Ulcus-Komplikationen: Stenose

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