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Gastric Outlet Obstruction

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Rickham's Neonatal Surgery

Abstract

Primary intrinsic obstruction to the outlet of the stomach in the neonate is a rare phenomenon, and in the previous edition of this book only five cases had been identified in the preceding 20 year period at the regional neonatal centre in Liverpool. The numbers are of course far outweighed by those children presenting with what is the most common surgically correctable cause of vomiting in the first few weeks of life—infantile hypertrophic pyloric stenosis (IHPS). The justification for including it in a textbook on neonatal surgery is two-fold. Not only do a percentage of the cases present within the true neonatal period, but given the numbers that present to regional neonatal units for management it is often the fledgling Paediatric Surgical trainee’s first exposure to the skills required to successfully manage neonatal cases, both in diagnostic and in operative management terms. This chapter will mainly focus on the current state of knowledge around IHPS; its aetiology, diagnosis and management, before concluding with comments around the pathologies leading to intrinsic obstruction.

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References

  1. Cook RCM. Gastric Outlet Obstruction. In: Lister J, Irving IM, editors. Neonatal Surgery. 3rd ed. London: Butterworth; 1990. p. 403–20.

    Google Scholar 

  2. Hirschsprung H. Falle van angeborenen Pylorusstenose, beobachtet bei Saenlingen. Jb kinderheilk. 1888;28:61.

    Google Scholar 

  3. Dufour H, Fredet P. La sclerose hypertrophique du pylore chez le nourisson et son traitment chirugical. Rev Chir. 1908;27:208–53.

    Google Scholar 

  4. Ramstedt C. Zur operation de angeborenen pylorus stenose. Medsch Klin. 1912;8:1702.

    Google Scholar 

  5. Lawson D. The incidence of pyloric stenosis in Dundee. Arch Dis Child. 1951;26:616–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dodge JA. Changing incidence of congenital pyloric stenosis. Br Med J. 1974;1:640.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Aspelund G, Langer JC. The current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. 2007;16:27–33.

    Article  PubMed  Google Scholar 

  8. Laron Z, Horne LM. The incidence of infantile pyloric stenosis. Am J Dis Child. 1957;94:151–4.

    CAS  Google Scholar 

  9. Cremin BJ, Klein A. Infantile pyloric stenosis: a 10 year survey. S Afr Med J. 1968;42:1056–60.

    CAS  PubMed  Google Scholar 

  10. Swan TT. Congenital pyloric stenosis in the African infant. Br Med J. 1961;1:545–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. McMahon B. The continuing enigma of pyloric stenosis of infancy: a review. Epidemiology. 2006;17:195–201.

    Article  Google Scholar 

  12. Kerr AM. Unprecedented rise in incidence of infantile hypertrophic pyloric stenosis. Br Med J. 1980;281:714–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Knox EG, Armstrong E, Haynes R. Changing incidence of infantile hypertrophic pyloric stenosis. Arch Dis Child. 1983;58:582–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Sommerfield T, Chalmers J, Youngson G, et al. the changing epidemiology of infantile hypertrophic pyloric stenosis. Arch. Dis. Child. 2008;93:1007–11.

    CAS  Google Scholar 

  15. Pedersen RN, Garne E, Loane M, et al. Infantile hypertrophic pyloric stenosis: a comparative study of incidence and other epidemiological characteristics in seven European regions. J Matern Fetal Neonatal Med. 2008;21:599–604.

    Article  PubMed  Google Scholar 

  16. Persson S, Ekbom A, Granath F, Nordenskjöld A. Parallel incidences of sudden infant death syndrome and infantile hypertrophic pyloric stenosis; a common cause? Pediatrics. 2001;108:379–81.

    Article  Google Scholar 

  17. Stringer MA, Brereton RJ. Current management of infantile hypertrophic pyloric stenosis. Br J Hosp Med. 1990;43:266–72.

    CAS  PubMed  Google Scholar 

  18. Jedd MB, Melton JL, Griffin MR, et al. Trends in infantile pyloric stenosis in Olmsted County, Minnesota. Pediatr Perinatol Epidemiol. 1988;2:148–57.

    Article  CAS  Google Scholar 

  19. Puri P, Lakschmanadass G. Hypertrophic pyloric stenosis. In: Puri P, editor. Newborn Surgery. Oxford: Butterworth-Heinemann; 1996. p. 266–71.

    Google Scholar 

  20. Gray S, Skandalakis J. Anomalies of the stomach. In: Gray S, Skandalakis J, editors. Embryology for surgeons. Philadelphia: Saunders; 1972. p. 105–6.

    Google Scholar 

  21. Evans NJ. Pyloric stenosis in preterm infants after transpyloric feeding. Lancet. 1982;ii:665.

    Article  Google Scholar 

  22. Thomson J. On congenital gastric spasm. Scot Med Surg. 1897;1:511.

    Google Scholar 

  23. Gabella G. Structure of muscle and nerves in the gastrointestinal tract. In: Johnson LR, editor. Physiology of the gastrointestinal tract. New York: Raven Press; 1994. p. 751–93.

    Google Scholar 

  24. Daniel EE, Tomita T, et al. Sphincters: normal function—changes in diseases. Boca Raton: CRC Press; 1992.

    Google Scholar 

  25. Armstrong G. An account of the diseases most incident to children from their birth to the age of puberty etc. London. 1777;

    Google Scholar 

  26. Everett KV, Capon F, et al. Linkage of monogenic infantile hypertrophic pyloric stenosis to chromosome 16q24. Eur J Hum Genet. 2008;16(9):1151–4.

    Article  CAS  PubMed  Google Scholar 

  27. Carter CO, Evans KA. Inheritance of congenital pyloric stenosis. J Med Genet. 1969;6:233–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ohshiro K, Puri P. Pathogenesis of infantile hypertrophic pyloric stenosis: recent progress. Pediatr Surg Int. 1998;13:243–52.

    Article  CAS  PubMed  Google Scholar 

  29. Pantelli C. New insights into the pathogenesis of infantile pyloric stenosis. Pediatr Surg Int. 2009;25:1043–52.

    Article  Google Scholar 

  30. Finsen VR. Infantile hypertrophic pyloric stenosis- unusual familial incidence. Arch Dis Child. 1979;54:720–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Garrow E, Hertzler J. Hypertrophic pyloric stenosis with jaundice: a case report of one family. J Pediat Surg. 1966;1:284–7.

    Article  CAS  PubMed  Google Scholar 

  32. Cockaigne EA, Penrose LS. Congenital pyloric stenosis in first cousins. Lancet. 1934;2:898.

    Article  Google Scholar 

  33. Danzer E, Schier F, et al. Smith-Lemli-Opitz syndrome: case report and literature review. J Pediatr Surg. 2006;35:1840–2.

    Article  Google Scholar 

  34. Jackson L, Kline AD, et al. de Lange syndrome: a clinical review of 310 individuals. Am J Med Genet. 1993;47:940–6.

    Article  CAS  PubMed  Google Scholar 

  35. Mitchell LE, Risch N. The genetics of infantile hypertrophic pyloric stenosis. A reanalysis. Am J Dis Child. 1991;147:1203–11.

    Article  Google Scholar 

  36. Carter CO. Inheritance of congenital pyloric stenosis. Br Med Bull. 1961;17:251–4.

    Article  CAS  PubMed  Google Scholar 

  37. Capon F, Reece A, et al. Linkage of monogenic infantile hypertrophic pyloric stenosis to chromosome 16p12-p13 and evidence for genetic heterogeneity. Am J Hum Genet. 2006;79:378–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Everett KV, Chioza BA, et al. Genome-wide high density SNP-based linkage analysis of infantile hypertrophic pyloric stenosis identifies loci on chromosomes 11q14-q22 and Xq23. Am J Hum Genet. 2008;82:756–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Chung E, Curtis D, et al. Genetic evidence for the neuronal nitric oxidase synthase gene (NOS1) as a susceptibility locus for infantile pyloric stenosis. Am J Hum Genet. 1996;58:363–70.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Saur D, Vanderwinden JM, et al. Single nucleotide promoter polymorphism alters transcription of neuronal nitric oxide synthase exon 1c in infantile hypertrophic pyloric stenosis. Proc Natl Acad Sci U S A. 2004;101:1662–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Sorensen HT, Skriver MV, Pedersen L, et al. Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 2003;35:104–6.

    Article  CAS  PubMed  Google Scholar 

  42. Webb AR, Lari J, Dodge JA. Infantile hypertrophic pyloric stenosis in South Glamorgan 1970-9. Effects of changes in feeding practice. Arch Dis Child. 1983;58:586–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Pisacane A, de Luca U, et al. Breast feeding and hypertrophic pyloric stenosis: population based case-control study. Br Med J. 1996;312:745–6.

    Article  CAS  Google Scholar 

  44. Latchaw LA, Jacir NN, et al. The development of pyloric stenosis during transpyloric feeding. J Pediatr Surg. 1989;24:823–4.

    Article  CAS  PubMed  Google Scholar 

  45. Muyaed R, Zaber K, Young DG, et al. Pyloric stenosis in sick premature infants. Lancet. 1984;ii:344–5.

    Article  Google Scholar 

  46. Mahon BE, Rosenman MB, Kleiman MB. Maternal and infant use of erythromycin and other macrolide antibiotics as risk factors for infantile hypertrophic pyloric stenosis. J Pediatr. 2000;139:380–4.

    Article  Google Scholar 

  47. Hauben M, Amsden GW. The association of erythromycin and infantile hypertrophic pyloric stenosis: causal or coincidental? Drug Saf. 2002;25:929–42.

    Article  CAS  PubMed  Google Scholar 

  48. Patole S, Rao S, Doherty D. Erythromycin as a prokinetic agent in preterm neonates: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2005;90:F301–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Fisher R, Lipshutz W, Cohen S. The hormonal regulation of pyloric sphincter function. J Clin Invest. 1973;52:1289–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Dodge JA. Production of duodenal ulcers and hypertrophic pyloric stenosis by the administration of pentagastrin to pregnant and newborn dogs. Nature. 1970;225:284–5.

    Article  CAS  PubMed  Google Scholar 

  51. Janik JS, Akbar AM, Burrington JD. The role of gastrin in congenital hypertrophic pyloric stenosis. J Pediatr Surg. 1978;13:151–4.

    Article  CAS  PubMed  Google Scholar 

  52. Spitz L, Zail S. Serum gastrin level congenital hypertrophic pyloric stenosis. J Pediatr Surg. 1976;11:33–5.

    Article  CAS  PubMed  Google Scholar 

  53. Wesley JR, Fiddian-Green R, Roi LD. The effects of pyloromyotomy on serum and luminal gastrin in infants with hypertrophic pyloric stenosis. J Surg Res. 1980;20:533–8.

    Article  Google Scholar 

  54. Hambourg MA, Mignon M, Ricour C. Serum gastrin levels in hypertrophic pyloric stenosis in infancy. Am J Dis Child. 1979;54:208–12.

    Article  CAS  Google Scholar 

  55. Grockowski J, Szafran H, Sztetkok K, et al. Blood serum immunoreactive gastrin level in infants with hypertrophic pyloric stenosis. J Pediatr Surg. 1980;15:279–82.

    Article  Google Scholar 

  56. Rogers IM, Drainer IK, et al. Plasma gastrin in congenital hypertrophic pyloric stenosis. A hypothesis disproved. Arch Dis Child. 1975;50:467–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Rogers IM, Drainer IK, et al. Serum cholecystokinin, basal acid secretion and infantile pyloric stenosis. Arch Dis Child. 1979;54:774–5.

    Article  Google Scholar 

  58. Rogers IM. The true cause of pyloric stenosis is hyperacidity. Acta Paediatr. 2006;95:132–6.

    Article  PubMed  Google Scholar 

  59. Wada T, Ishizawa M. Effects of prostaglandins on the function of the gastric secretion. Jpn J Clin Med. 1970;28:2465–8.

    CAS  Google Scholar 

  60. La Ferla G, Watson J, et al. The role of prostaglandins E2 and F2 alpha in infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1986;21:410–312.

    Article  Google Scholar 

  61. Goyal RK, Mukhopadhyay A, Rattan S. Effect if prostaglandin E2 on the lower esophageal sphincter in normal subjects and patients with achalasia. Clin Res. 1974;22:358A.

    Google Scholar 

  62. Shinohara K, Shimizu T, et al. Correlation of prostaglandin E2 production and gastric acid secretion in infants with hypertrophic pyloric stenosis. J Pediatr Surg. 1998;33:1483–5.

    Article  CAS  PubMed  Google Scholar 

  63. Dieler R, Schroder GM, et al. Infantile hypertrophic pyloric stenosis : myopathic type. Acta Neuropathol. 1990;80:295–306.

    Article  CAS  PubMed  Google Scholar 

  64. Langer JC, Berezin I, et al. Hypertrophic pyloric stenosis: ultrastructural abnormalities of enteric nerves and the interstitial cells of Cajal. J Pediatr Surg. 1995;30:1535–43.

    Article  CAS  PubMed  Google Scholar 

  65. Guarino N, Shima H, et al. Structural immaturity of the pylorus muscle in infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 2000;16:282–4.

    Article  CAS  PubMed  Google Scholar 

  66. Gentile C, Romeo C, et al. A possible role of the plasmalemnal cytoskeleton, nitric oxide synthetase, and innervation in infantile hypertrophic pyloric stenosis. A confocal laser scanning microscope study. Pediatr Surg Int. 1998;14:45–50.

    Article  CAS  PubMed  Google Scholar 

  67. Belding HH, Kernohan JW. A morphological study of the myenteric plexus with special reference to changes in hypertrophic pyloric stenosis. Surg Gynecol Obstet. 1953;97:323–34.

    Google Scholar 

  68. Alarotu H. The histopathologic changes in the myenteric plexus of the pylorus in hypertrophic pyloric stenosis of infants (pylorospasm). Act Paediatr Scan. 1956;45(Suppl 107):1–131.

    CAS  Google Scholar 

  69. Cass DT, Zhang AL. Extracellular matrix changes in congenital hypertrophic pyloric stenosis. Pediatr Surg Int. 1991;6:190–4.

    Article  Google Scholar 

  70. Oue T, Puri P. Abnormalities of elastin and elastic fibres in infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 1999;15:540–2.

    Article  CAS  PubMed  Google Scholar 

  71. Miyazaki E, Yamataka T, et al. Active collagen synthesis in infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 1998;13:237–9.

    Article  CAS  PubMed  Google Scholar 

  72. Weinstein R, Stemmerma MB, Maciag T. Hormoanl requirements for growth of arterial smooth muscle cells in vitro: an endocrine approach to atherosclerosis. Science. 1981;212:818.

    Article  CAS  PubMed  Google Scholar 

  73. Han VKM, D’Ercole AJ, Lund PK. Cellular localization of somatomedin (insulin-like growth factor) messenger RNA in the human fetus. Science. 1987;236:193–7.

    Article  CAS  PubMed  Google Scholar 

  74. Czech M. Structural and functional homologies in the receptors for insulin and the insulin-like growth factors. Cell. 1982;31:8–10.

    Article  CAS  PubMed  Google Scholar 

  75. Ohshiro K, Puri P. Increased insulin-like growth factor –I mRNA expression in pyloric muscle in infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 1998;13:253–5.

    Article  CAS  PubMed  Google Scholar 

  76. Ohshiro K, Puri P. Increased insulin-like growth factor and platelet-derived growth factor system in the pyloric muscle in infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1998;33:378–81.

    Article  CAS  PubMed  Google Scholar 

  77. Jablonski J, Gawronska R, et al. Study of insulin-like growth factor-1 (IGF-1) and platelet-derived endothelial cell growth factor(PDEGF) expression on children with infantile hypertrophic pyloric stenosis. Med Sci Monit. 2006;12:CR27–30.

    CAS  PubMed  Google Scholar 

  78. Shima H, Puri P. Increased expression of transforming growth factor-alpha in infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 1999;15:198–200.

    Article  CAS  PubMed  Google Scholar 

  79. Shima H, Oshiro K, et al. Increased local synthesis of epidermal growth factors in infantile hypertrophic pyloric stenosis. Pediatr Res. 2000;47:201–7.

    Article  CAS  PubMed  Google Scholar 

  80. Meeker CS, de Nicola RR. Hypertrophic pyloric stenosis in a newborn infant. J Pediatr. 1948;33:94–7.

    Article  CAS  PubMed  Google Scholar 

  81. Friesen SR, Boley JO, Miller DR. The myenteric plexus of the pylorus. Surgery. 1956;39:21–9.

    CAS  PubMed  Google Scholar 

  82. Rintoul JR, Jirkham NF. The myenteric plexus in infantile pyloric stenosis. Arch Dis Child. 1961;36:474–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Tam PKH. Observations and perspectives on the possible aetiology of infantile pyloric stenosis: a histological, biochemical, histochemical and immunochemical study. Ann Acad Med Singap. 1985;14:523–9.

    CAS  PubMed  Google Scholar 

  84. Jona JZ. Electron microscopic observations in infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1978;13:17–20.

    Article  CAS  PubMed  Google Scholar 

  85. Sugimura K, Haimoto H, Nagura H, et al. Immunohistochemical differential distribution of S-100a and S-100β in the peripheral nervous system of the rat. Muscle Nerve. 1989;12:919–35.

    Article  Google Scholar 

  86. Kobyashi H, O’Briain DS, et al. Selective reduction in intramuscular nerve supporting cells in infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1994;29:651–4.

    Article  Google Scholar 

  87. Guarino N, Yoneda A, et al. Selective neurotrophin deficiency in infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 2001;36:1280–4.

    Article  CAS  Google Scholar 

  88. Thuneberg L. Interstitial cells of Cajal: intestinal pacemaker cells. Adv Anat Embryol Cell Biol. 1982;71:1–130.

    Article  CAS  PubMed  Google Scholar 

  89. Huizinga JD, Lammers WJ. Gut peristalsis is governed by a multitude of co-operating mechanisms. Am J Physiol Gastrointest Liver Physiol. 2009;296(1):G1–8.

    Article  CAS  PubMed  Google Scholar 

  90. Vanderwinden JM, Liu H, et al. Study of the interstitial cells of Cajal in infantile hypertrophic pyloric stenosis. Gastroenterology. 1996;111:279–88.

    Article  CAS  PubMed  Google Scholar 

  91. Yamataka A, Fujiwara T, et al. Lack of intestinal pacemaker (C-KIT-positive) cells in infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1996;31:96–8.

    Article  CAS  PubMed  Google Scholar 

  92. Okazaki T, Yamataka A, et al. Abnormal distribution of synaptic vesicle proteins in infantile hypertrophic pyloric stenosis. J Pediatr Gastroenterol Nutr. 1994;18:254–5.

    Article  CAS  PubMed  Google Scholar 

  93. Kobyashi H, O’Briain DS, et al. Immunochemical characterisation of neural cell adhesion molecule (NCAM), nitric oxide synthase, and neurofilament protein expression in pyloric muscle of patients with pyloric stenosis. J Pediatr Gastroenterol Nutr. 1995;20:319–25.

    Article  Google Scholar 

  94. Malmfors G, Sundler F. Peptidergic innervation in infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1986;21:303–6.

    Article  CAS  PubMed  Google Scholar 

  95. Wattchow DA, Cass DT, et al. Abnormalities of peptide containing nerve fibers in infantile hypertrophic pyloric stenosis. Gastroenterology. 1987;92:443–8.

    Article  CAS  PubMed  Google Scholar 

  96. Shen Z, She Y, et al. Immunohistochemical study of peptidergic nerves in infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 1990;5:110–3.

    Article  Google Scholar 

  97. Blut H, Boeckxstaens GE, Pelckmans PA, et al. Nitric oxide as an inhibitory non-adrenergic non-cholinergice neurotransmitter. Nature. 1990;345:346–7.

    Article  Google Scholar 

  98. Vanderwinden JM, Mailleux P, et al. Nitric oxide synthetase activity in infantile hypertrophic pyloric stenosis. N Engl J Med. 1992;327:511–5.

    Article  CAS  PubMed  Google Scholar 

  99. Huang PL, Dawson TM, et al. Targeted disruption of the neuronal nitric oxide synthase gene. Cell. 1993;75:1273–86.

    Article  CAS  PubMed  Google Scholar 

  100. Huang LT, Tiao MM, et al. Low plasma nitrite in infantile pyloric stenosis patients. Dig Dis Sci. 2006;51:869–72.

    Article  CAS  PubMed  Google Scholar 

  101. Subramanian R, Doig CM, et al. Nitric oxide synthase is absent only on a subset of cases of pyloric stenosis. J Pediatr Surg. 2001;36:616–9.

    Article  Google Scholar 

  102. Rendle-Short J, Zachary RB. Congenital pyloric stenosis in older babies. Arch Dis Child. 1955;30:70–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Spicer RD. Infantile pyloric stenosis: a review. Br J Surg. 1982;69:128–35.

    Article  CAS  PubMed  Google Scholar 

  104. Bissonette B, Sullivan PJ. Pyloric stenosis. Can J Anaesth. 1991;38(5):668–76.

    Article  Google Scholar 

  105. Read HS, Wyatt JP, Lamont GL, et al. Pyloric stenosis in preterm twins. J R Coll Surg Edinb. 1994;39:187–8.

    CAS  PubMed  Google Scholar 

  106. White JS, Clements WDB, Heggarty P, et al. Treatment of infantile hypertrophic pyloric stenosis in a district general hospital: a review of 160 cases. J Pediatr Surg. 2003;38:1333–6.

    Article  CAS  PubMed  Google Scholar 

  107. Irish MS, Pearl RH, Caty MG, et al. The approach to common abdominal diagnoses in infants and children. Pediatr Clin N Am. 1998;45:729–72.

    Article  CAS  Google Scholar 

  108. Toyama WM. Infantile hypertrophic pyloric stenosis (an improved technique for diagnosis). Am J Surg. 1969;117:650–2.

    Article  CAS  PubMed  Google Scholar 

  109. Scharli AF, Sieber WK, Kiesewetter WB. Hypertrophic pyloric stenosis at the Children’s Hospital of Pittsburg from 1912 to 1967. A critical review of current problems and complications. J Pediatr Surg. 1969;4:108–14.

    Article  CAS  PubMed  Google Scholar 

  110. Mullassery D, Mallappa S, Shariff S, et al. Negative exploration for pyloric stenosis – is it preventable? BMC Pediatr. 2008;8:37.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Macdessi J, Oates RK. Clinical diagnosis if pyloric stenosis: a declining art. Br Med J. 1993;306:553–5.

    Article  CAS  Google Scholar 

  112. Teele RL, Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med. 1977;296:1149–50.

    Article  CAS  PubMed  Google Scholar 

  113. Strunden RJ, Le Quesne GW, Little KET. The improved ultrasound diagnosis of hypertrophic pyloric stenosis. Pediat Radiol. 1986;16:200–5.

    Article  Google Scholar 

  114. Neilson D, Hollman AS. The ultrasonic diagnosis of infantile hypertrophic pyloric stenosis: technique and accuracy. Clin Radiol. 1994;49:246–7.

    Article  CAS  PubMed  Google Scholar 

  115. Godbole P, Sprigg A, Dickson JAS, et al. Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis. Arch Dis Child. 1996;75:335–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  116. Tunnell WP, Wilson DA. Pyloric stenosis: diagnosis by real time ultrasonography, the pyloric muscle length method. J Pediatr Surg. 1984;19:795–9.

    Article  Google Scholar 

  117. Carver RA, Okorie M, Steiner GM, et al. Infantile hypertrophic pyloric stenosis- diagnosis from the pyloric muscle index. Clin Radiol. 1988;38:625–7.

    Article  Google Scholar 

  118. Meuwissen T, Shoff J. Roentgen examination of the pyloric canal of infants with hypertrophic pyloric stenosis. Am J Dis Child. 1934;48:1304–15.

    Google Scholar 

  119. Hernanz-Schulman M, Sells LL, Ambrosino MM, et al. Hypertrophic pyloric stenosis in an infant without a palpable olive: accuracy of sonographic diagnosis. Radiology. 1994;193:771–6.

    Article  CAS  PubMed  Google Scholar 

  120. Larsen GL. Limitations of roentgenographic examination in the diagnosis of infantile hypertrophic pyloric stenosis. Surgery. 1966;60:768–72.

    CAS  PubMed  Google Scholar 

  121. De Backer A, Bové T, Vandenplas Y, Peeters S, Deconinck P. Contribution of endoscopy to early diagnosis of hypertrophic pyloric stenosis. J Pediatr Gastroenterol Nutr. 1994;18:78–81.

    Article  PubMed  Google Scholar 

  122. Ward E, Easley D, Pohl J. Previously unsuspected infantile hypertrophic pyloric stenosis diagnosed by endoscopy. Dig Dis Sci. 2008;53:946–8.

    Article  PubMed  Google Scholar 

  123. Magnall YF, Baxter AJ, Avill R, et al. Applied potential tomography: a new non-invasive technique for assessing gastric function. Clin Phys Physiol Meas. 1987;8(Suppl A):63–70.

    Google Scholar 

  124. Lamont GL, Wright JW, Evans DF, et al. An evaluation of applied potential tomography in the diagnosis of infantile hypertrophic pyloric stenosis. Clin Phys Physiol Meas. 1988;9(Suppl A):65–9.

    Article  PubMed  Google Scholar 

  125. Todres DI, Firestone S. Neonatal emergencies. In: Ryan JF, Cot CJ, Todres DI, Goudsouzian N, editors. A practice of anesthesia for infants and children. Boston: Grune and Stratton Inc.; 1986. p. 152.

    Google Scholar 

  126. Benson CD, Lloyd JR. Infantile pyloric stenosis: a review of 1,120 cases. Am J Surg. 1964;107:429–33.

    Article  CAS  PubMed  Google Scholar 

  127. Cordua E. Ein Fall von einem monstrosen Blindsac des Dickdarms. Goettingen: Dieterich; 1892.

    Google Scholar 

  128. Cantley E, Dent CT. Congenital hypertrophic pyloric stenosis and its treatment by pyloroplasty. Med Chir Trans. 1903;86:471.

    Google Scholar 

  129. Tan KC, Bianchi A. Circumbilical incision for pyloromyotomy. Br J Surg. 1986;73:399.

    Article  CAS  PubMed  Google Scholar 

  130. Fitzgerald PG, Lau GY, Langer JC, et al. Umbilical fold incision for pyloromyotomy. J Pediatr Surg. 1990;25:1117–8.

    Article  CAS  PubMed  Google Scholar 

  131. Khan AR, Al-Bassam AR. Circumbilical pyloromyotomy: larger pyloric tumours need an extended incision. Pediatr Surg Int. 2000;16:338–41.

    Article  CAS  PubMed  Google Scholar 

  132. Leinwand MJ, Shaul DB, Anderson KD. The umbilical fold approach to pyloromyotomy: is it a safe alternative to the right upper quadrant approach? J Am Coll Surg. 1999;189:362–7.

    Article  CAS  PubMed  Google Scholar 

  133. Kim SS, Lau ST, Lee SL, et al. Pyloromyotomy: a comparison of laparoscopic, circumbilical, and right upper quadrant operative techniques. J Am Coll Surg. 2005;201:66–70.

    Article  PubMed  Google Scholar 

  134. Blumer RM, Hessel NS, van Baren R, et al. Comparison between umbilical and transverse right upper abdominal incision for pyloromyotomy. J Pediatr Surg. 2004;39:1091–3.

    Article  CAS  PubMed  Google Scholar 

  135. Shankar KR, Losty PD, Jones MO, et al. Umbilical pyloromyotomy: an alternative to laparoscopy? Eur J Pediatr Surg. 2001;11:8–11.

    Article  CAS  PubMed  Google Scholar 

  136. Alain JL, Grousseau D, Terrier T. Extramucosal pyloromyotomy by laparoscopy. Surg Endosc. 1991;5:174–5.

    Article  CAS  PubMed  Google Scholar 

  137. Scharli AF, Leditschke JF. Gastric motility after pyloromyotomy in infants: a reappraisal of postoperative feeding. Surgery. 1968;64:1113–7.

    Google Scholar 

  138. Wheeler RA, Najmaldin AS, Stoodley N, et al. Feeding regimens after pyloromyotomy. Br J Surg. 1990;77:1018–9.

    Article  CAS  PubMed  Google Scholar 

  139. Georgeson KE, Corbin TJ, Griffen JW, et al. An analysis of feeding regimens after pyloromyotomy for hypertrophic pyloric stenosis. J Pediatr Surg. 1993;28:1478–80.

    Article  CAS  PubMed  Google Scholar 

  140. Gollin G, Doslouglu H, Flummerfeldt P, et al. Rapid advancement of feedings after pyloromyotomy for pyloric stenosis. Clin Pediatr. 2000;39:187–90.

    Article  CAS  Google Scholar 

  141. Robertson DE. Congenital pyloric stenosis. Ann Surg. 1940;112:687–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  142. Crabbe DCG. Infantile hypertrophic pyloric stenosis. In: Stringer MD, Oldham KT, PDE M, editors. Pediatric surgery and urology. Long-term outcomes. 2nd ed: Cambridge University Press; 2006. p. 296–304.

    Google Scholar 

  143. Pranikoff T, Campbell B, Travis J, Hirschl R. Differences in outcome with subspecialty care: pyloromyotomy in North Carolina. J Pediatr Surg. 2002;37:352–6.

    Article  PubMed  Google Scholar 

  144. Langer JC, To T. Does pediatric surgical specialty training affect outcome after Ramstedt pyloromyotomy? A population-based study. Pediatrics. 2004;113(5):1342–7.

    Article  PubMed  Google Scholar 

  145. Safford SD, Pietrobon R, Safford KM, et al. A study of 11,003patients with hypertrophic pyloric stenosis and the associations between surgeon and hospital volume and outcomes. J Pediatr Surg. 2005;40:967–97.

    Article  PubMed  Google Scholar 

  146. Beynon J, Brown R, James C, et al. Pyloromyotomy: can the morbidity be improved? J R Coll Surg Edinb. 1987;32:291–2.

    CAS  PubMed  Google Scholar 

  147. Hight DW, Benson CD, Philippart AI, et al. Management of mucosal perforation during pyloromyotomy for infantile pyloric stenosis. Surgery. 1981;90:85–6.

    CAS  PubMed  Google Scholar 

  148. Lee SL, Sydorak RM, Lau ST. Air insufflation of the stomach following laparoscopic pyloromyotomy may not detect perforation. JSLS. 2010;14:60–1.

    Article  PubMed  PubMed Central  Google Scholar 

  149. Koop CE. Pyloromyotomy for pyloric stenosis. In: Cooper P, editor. The craft of surgery. Boston, MA: Little Brown; 1964. p. 1450–7.

    Google Scholar 

  150. Royal RE, Linz DN, Gruppo DL, et al. Repair of mucosal perforation during pyloromyotomy: surgeon’s choice. J Pediatr Surg. 1995;30:1430–2.

    Article  CAS  PubMed  Google Scholar 

  151. Sitsen E, Bax NMA, van der Zee DC. Is laparoscopic pyloromyotomy superior to open surgery? Surg Endosc. 1998;12:813–5.

    Article  CAS  PubMed  Google Scholar 

  152. British Association of Paediatric Surgeons. Comparative audit service – paediatric surgery. London, UK: Surgical Epidemiology Unit, Royal College of Surgeons of England; 1996.

    Google Scholar 

  153. Ford WD, Crameri JA, Holland AJ. The learning curve for laparoscopic pyloromyotomy. J Pediatr Surg. 1997;32:552–4.

    Article  CAS  PubMed  Google Scholar 

  154. Eriksen CA, Anders CJ. Audit of results of operations for infantile hypertrophic pyloric stenosis in a district general hospital. Arch Dis Child. 1991;66:130–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  155. Harvey MH, Humphrey G, Fieldman N, et al. Abdominal wall dehiscence following Ramstedt’s operation; a review of 170 cases of infantile hypertrophic pyloric stenosis. Br J Surg. 1991;78:81–2.

    Article  CAS  PubMed  Google Scholar 

  156. Huddart SN, Bianchi A, Kumar V, et al. Ramstedt’s pyloromyotomy: circumbilical versus transverse approach. Pediatr Surg Int. 1993;8:395–6.

    Google Scholar 

  157. Nour S, MacKinnon AE, Dickson JAS, et al. Antibiotic prophylaxis for infantile pyloromyotomy. J Roy Coll Surg Ed. 1996;41:178–80.

    CAS  Google Scholar 

  158. Mullassery D, Perry D, Goyal A, et al. Surgical practice for infantile hypertrophic pyloric stenosis in the United Kingdom and Ireland – a survey of members of the British Association of Paediatric Surgeons. J Pediatr Surg. 2008;43:1227–9.

    Article  PubMed  Google Scholar 

  159. Gauderer MW. Experience with a nonlaparoscopic, transumbilical, intracavitary pyloromyotomy. J Pediatr Surg. 2008;43:884–8.

    Article  PubMed  Google Scholar 

  160. Mullassery D, Shariff R, Craigie RJ, et al. Umbilical pyloromyotomy: comparison of vertical linea alba and transverse muscle cutting incisions. J Pediatr Surg. 2007;42:525–7.

    Article  PubMed  Google Scholar 

  161. Hall NJ, Van der Zee J, Tan HL, et al. Meta analysis of laparoscopic versus open pyloromyotomy. Ann Surg. 2004;240:774–8.

    Article  PubMed  PubMed Central  Google Scholar 

  162. Siddiqui S, Heidel RE, Angel CA, Kennedy AP Jr. Pyloromyotomy: randomized control trial of laparoscopic vs open technique. J Pediatr Surg. 2012;47:93–8.

    Article  PubMed  Google Scholar 

  163. Jia WQ, Tian JH, Yang KH, Ma B, Liu YL, Zhang P, Li RJ, Jia RH. Open versus laparoscopic pyloromyotomy for pyloric stenosis: a meta-analysis of randomized controlled trials. Eur J Pediatr Surg. 2011;21:77–81.

    Article  PubMed  Google Scholar 

  164. Sola JE, Neville HL. Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis. J Pediatr Surg. 2009;44:1631–7.

    Article  PubMed  Google Scholar 

  165. Centre for Review and Dissemination. Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis (structured Abstract) Database of Abstracts of Review of Effects, vol. 3. New York: Wiley\University of York; 2011.

    Google Scholar 

  166. Katz MS, Schwartz MZ, Moront ML, et al. Prophylactic antibiotics do no decrease the incidence of wound infections after laparoscopic pyloromyotomy. J Pediatr Surg. 2011;46:1086–8.

    Article  PubMed  Google Scholar 

  167. Wollstein M. Healing of hypertrophic pyloric stenosis after the Fredet-Rammstedt operation. Am J Dis Child. 1922;23:511–7.

    Google Scholar 

  168. Steinicke O, Roelsgaard M. Radiographic follow-up in hypertrophic pyloric stenosis. Acta Paediatr. 1960;49:4–16.

    Article  CAS  Google Scholar 

  169. Okorie NM, Dickson JAS, Carver RA, et al. What happens to the pylorus after pyloromyotomy? Arch Dis Child. 1988;63:1339–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  170. Tander B, Akalin A, Abbasoglu L, et al. Ultrasonographic follow up of infantile hypertrophic pyloric stenosis after pyloromyotomy: a controlled prospective study. Eur J Ped Surg. 2002;12:379–82.

    Article  CAS  Google Scholar 

  171. Steinicke Nielson O, Roelsgaard M. Roentgenologically demonstrable gastric abnormalities in cases of previous congenital pyloric stenosis. Acta Radiol. 1956;45:273–82.

    Article  Google Scholar 

  172. Solowiejczyk M, Holtzman M, Michowitz M. Congenital hypertrophic pyloric stenosis: a long term follow up of 41 cases. Am Surg. 1980;10:567–71.

    Google Scholar 

  173. Wanscher B, Jensen H. Late follow-up studies after operation for congenital pyloric stenosis. Scand J Gastroenterol. 1971;6:597–9.

    Article  CAS  PubMed  Google Scholar 

  174. Ludtke FE, Bertus M, Voth E, et al. Gastric emptying 16 to 26 years after treatment of infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1994;29:523–6.

    Article  CAS  PubMed  Google Scholar 

  175. Rasmussen L, Oster-Jorgensen E, Hansen LP, et al. Gastric emptying in adults treated for infantile hypertrophic pyloric stenosis. Acta Chir Scand. 1989;155:471–3.

    CAS  PubMed  Google Scholar 

  176. Asai A, Takehara H, Harada M, et al. Ultrasonographic evaluation of gastric emptying in normal children and children after pyloromyotomy. Pediatr Surg Int. 1997;12:344–7.

    Article  CAS  PubMed  Google Scholar 

  177. Sun WM, Doran SM, Jones KL, et al. Long term effects of pyloromyotomy on pyloric motility and gastric emptying in humans. Am J Gastroenterol. 2000;95:92–100.

    Article  CAS  PubMed  Google Scholar 

  178. Stringer MD, Kiely E, Drake DP. Gastric retention of swallowed coins after pyloromyotomy. Br J Clin Pract. 1991;45:66–7.

    CAS  PubMed  Google Scholar 

  179. Hayashi A, Giacomantonio JM, Lau HYC, et al. Balloon catheter dilatation for hypertrophic pyloric stenosis. J Pediatr Surg. 1990;25:1119–21.

    Article  CAS  PubMed  Google Scholar 

  180. Ogawa Y, Higashimoto Y, Nishijima E, et al. Successful endoscopic balloon dilatation for hypertrophic pyloric stenosis. J Pediatr Surg. 1996;31:1712–4.

    Article  CAS  PubMed  Google Scholar 

  181. Tobler L. Ueber Magen verdauung der Milch. Munch Med Wschr. 1907;54:812.

    Google Scholar 

  182. Ibrahim J. Die angeborenen Pylorusstenose in Senglingsalter. Berlin: S Karger; 1905.

    Google Scholar 

  183. Swensgaard E. Medical treatment of congenital pyloric stenosis. Hospitalstudende. 1935;78:833.

    Google Scholar 

  184. Tallerman KH. Discussion on treatment of congenital hypertrophic pyloric stenosis. Proc Roy Soc Med. 1951;44:1055–7.

    CAS  PubMed  Google Scholar 

  185. Yamataka A, Tsukada K, Yokoyama-Laws Y, et al. Pyloromyotomy versus atropine sulfate for infantile hypertrophic pyloric stenosis. Surg. 2000;35:338–42.

    CAS  Google Scholar 

  186. Kawahara H, Imura K, Nishikawa M, Yagi M, Kubota A. Intravenous atropine treatment in infantile hypertrophic pyloric stenosis. Arch Dis Child. 2002;87:71–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  187. Kawahara H, Takama Y, Yoshida H, et al. Medical treatment of hypertrophic pyloric stenosis: should we always slice the “olive”? J Pediatr Surg. 2005;40:1848–51.

    Article  PubMed  Google Scholar 

  188. Aguayo P, Ostlie DJ. Duodenal and Intestinal Atresia and Stenosis. In: Holcomb III GW, Murphy JP, editors. Ashcraft’s Paediatric Surgery. 5th ed. Philadelphia: Saunders Elsevier; 2010. p. 400.

    Chapter  Google Scholar 

  189. Ilce BZ, Erdogan E, Kara C, Celayir S, Sarimurat N, Snyuz OF, Yeker D. Pyloric atresia: 15-year review from a single institution. J Pediatr Surg. 2003;38:1581–4.

    Article  PubMed  Google Scholar 

  190. Koontz SC, Wulkan M. Lesions of the stomach. In: Holcomb III GW, Murphy JP, editors. Ashcraft’s paediatric surgery. 5th ed. Philadelphia: Saunders Elsevier; 2010. p. 395–6.

    Google Scholar 

  191. Muller M, Morger R, Engert J. Pyloric atresia: report of two cases and review of literature. Pediatr Surg Int. 1990;5:276–9.

    Article  Google Scholar 

  192. Moore CCM. Congenital gastric outlet obstruction. J Pediatr Surg. 1989;24:1241–6.

    Article  CAS  PubMed  Google Scholar 

  193. Egan N, Ward R, Olmstead M, Marks JG. Junctional epidermolysis bullosa and pyloric atresia in two siblings. Arch Dermatol. 1985;121:1186–8.

    Article  CAS  PubMed  Google Scholar 

  194. Bar-Maor JA, Nissan S, Nevo S. Pyloric atresia: a hereditary congenital anomaly with autosomal recessive transmission. J Med Genet. 1972;9:70–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  195. Chung HJ, Uitto J. Epidermolysis bullosa with pyloric atresia. Dermatol Clin. 2010;28:43–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  196. Al-Salem AH. Congenital pyloric atresia and associated anomalies. Pediatr Surg Int. 2007;23(6):559–63.

    Article  PubMed  Google Scholar 

  197. Sencan A, Mir E, Karace I, Günşar C, Sencan A, Topçu K. Pyloric atresia associated with multiple intestinal atresias and pylorocholedochal fistula. J Pediatr Surg. 2002;37:1223–4.

    Article  PubMed  Google Scholar 

  198. Tandler J. Zur Emtwicklungsgeschichte des menschlichen Doudenum im fruhen embryonen Stadien. Gegenbaur Morph Jahrbuch. 1900;29:187–216.

    Google Scholar 

  199. Louw JH, Barnard CN. Congenital intestinal atresia; observations on its origin. Lancet. 1955;269:1065–7.

    Article  CAS  PubMed  Google Scholar 

  200. Tunnel WP, Smith EI. Antral web in infancy. J Pediatr Surg. 1980;15:152–5.

    Article  Google Scholar 

  201. Boyden EA, Cope JG, Bill AH. Anatomy and embryology of congenital intrinsic obstruction of the duodenum. Am J Surg. 1967;114:190–2.

    Article  CAS  PubMed  Google Scholar 

  202. Maman E, Maor E, Kachko L, et al. Epidermolysis bullosa, pyloric atresia, aplasia cutis congenita: histopathological delineation of an autosomal recessive disease. Am J Med Genet. 1998;78:127–33.

    Article  CAS  PubMed  Google Scholar 

  203. Nazzaro V, Nicolini U, De Luca L, et al. Prenatal diagnosis of junctional epidermolysis bullosa associated with pyloric atresia. J Med Genet. 1990;27:244–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  204. Sloop RD, Montague AC. Gastric outlet obstruction due to congenital pyloric mucosal membrane. Ann Surg. 1967;165:598–604.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  205. Gahukamble DB. Familial occurrence of congenital incomplete prepyloric mucosal diaphragm. J Med Genet. 1998;35(12):1040–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  206. Clement KW, Escamilla HA. Duplication of the stomach. J Nat Med Assoc. 1974;66:292–304.

    Google Scholar 

  207. Upadhyaya VD, Srivastava PK, Jaiman R, et al. Duplication cyst of pyloroduodenal canal: a rare cause of neonatal gastric outlet obstruction. Cases J. 2009;2:42.

    Article  PubMed  PubMed Central  Google Scholar 

  208. Holcomb GW 3rd, Gheissari A, O'Neill JA Jr, et al. Surgical management of alimentary tract duplications. Ann Surg. 1989;209(2):167–71.

    Article  PubMed  PubMed Central  Google Scholar 

  209. Sorbie AL, Symon DN, Sotockdale EJ. Gaviscon bezoars. Arch Dis Child. 1984;59:905–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  210. Heinz-Erian P, Gassner I, Klein-Franke A, et al. Gastric lactobezoar—a rare disorder? Orphanet J Rare Dis. 2012;7:3.

    Article  PubMed  PubMed Central  Google Scholar 

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Lamont, G.L. (2018). Gastric Outlet Obstruction. In: Losty, P., Flake, A., Rintala, R., Hutson, J., lwai, N. (eds) Rickham's Neonatal Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-4721-3_30

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