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Hypertrophy of the Pyloric Muscle in Adults

1963; Radiological Society of North America; Volume: 80; Issue: 5 Linguagem: Inglês

10.1148/80.5.753

1527-1315

William B. Seaman,

Congenital Diaphragmatic Hernia Studies

The radiological appearance of hypertrophy of the pyloric muscle in the adult is characteristic according to many authors, and yet a preoperative diagnosis is seldom made with confidence. Kirklin and Harris (35) in their classical study of 81 patients predicted that a crescentic indentation of the base of the duodenal bulb in conjunction with prepyloric narrowing would prove to be pathognomonic of this condition even though only 1 of their 81 reported cases had been correctly diagnosed before operation. The accuracy of the roentgen diagnosis has not improved, however, according to more recent reports. Because of this diagnostic dilemma and the relative infrequency of the condition, the experience with this entity at the Columbia-Presbyterian Medical Center was reviewed. Clinical Material The roentgenograms and hospital records of 27 patients were studied and the essential data were tabulated (Table I). Only those subjects with histologically proved pyloric muscle hypertrophy and roentgenograms available for review were included in this study with 1 exception, a patient who was operated upon, with gross findings so typical that no biopsy was performed. The youngest patient was thirty-four years old and the oldest eighty-two but the great majority were over fifty. The striking preponderance of males (9:1) is in accord with the sex incidence reported by others which varies from 19:1 (31) to 3:1 (45) in favor of men. In infants it occurs approximately seven times oftener in boys (13). A detailed clinical analysis was not attempted because of the absence of a definite pattern. The clinical picture seems ill defined except when associated with peptic ulceration; it then seems to coincide with the signs and symptoms usually found in patients with gastric ulcers. The so-called pyloric syndrome of epigastric pain exacerbated by food, not relieved by antacids, and associated with frequent vomiting did not occur (57). Significant vomiting was encountered in one-third of the patients but in the majority it was not a prominent symptom. The duration of the symptoms varied from one day to thirty years but in none could it be traced back to infancy. Pathology The gross appearance of pyloric hypertrophy in the adult is similar to that in infancy. However, the pathologic criteria have not been precisely defined. Horwitz et al. (26) found that the pyloric muscle, measured after fixation, varied in thickness from 3.8 to 8.5 mm. with an average of 5.8 mm. in 47 adults without known gastroduodenal disease. Craver (13) measured the average thickness of fresh specimens before fixation at 4.4 mm. in 10 autopsy specimens and 7.1 mm. in 15 surgical specimens. In 10 fresh autopsy stomachs Knight (36) found an average thickness of 5 mm. with a range from 4 to 7 mm.