Stomach and Duodenum

Abstract

21.1

General considerations

■ Hypertrophy of the pyloric muscle causes gastric outlet obstruction

■ Incidence 1:250 live births, most common in Caucasian populations

■ 4:1 male-to-female ratio

■ Family history often positive, particularly sons born to affected mothers, indicating a polygenic pattern of inheritance

■ Etiology largely unknown

21.2

Hypertrophy of the pyloric muscle causing gastric outlet obstruction is a common condition of unknown etiology. The prognosis is excellent, with definitive surgery following adequate resuscitation.

21.3

General considerations

■ Incidence about 1:10,000 births

■ Approximately 70% of congenital intestinal stenoses and 45% of atresias are found in the duodenal region

■ 30% have trisomy 21 (Down’s syndrome)

■ Diagnosis is possible antenatally

• 17%–57% have associated polyhydramnios

• Antenatal ultrasonography may identify a dilated stomach and proximal duodenum (double-bubble)

• Antenatal diagnosis should prompt a detailed search for associated anomalies and amniocentesis

■ The majority of cases are diagnosed in the early newborn period

■ Other associated anomalies include:

• Congenital heart disease (~20%)

• Malrotation (~20%)

• Esophageal atresia and tracheo-esophageal fistula (~20%)

• Genito-urinary anomalies (~9%)

• Anorectal anomalies (~3%)

• VACTERL association (vertebral abnormalities, anal atresia, cardiac abnormalities, tracheoesophageal fistula and/or esophageal atresia, renal agenesis and dysplasia and limb defects)