Adult hypertrophic pyloric stenosis

　　First, etiology

　　The etiology of adult hypertrophic pyloric stenosis is not very clear, and it is generally divided into two types, namely primary and secondary. Most of the reported cases in the first half of the 20th century were secondary, mainly accompanied by a history of gastric ulcer, duodenal ampulla ulcer, cancer, postoperative adhesion, and gastric stone, and related to the long-term spasm of the pyloric sphincter due to local inflammation and ulcers. Some people believe that the disease is the continuation of infantile hypertrophic stenosis, and 20% have a history of vomiting and surgery after birth. Primary cases are rare and are mostly the continuation of congenital hypertrophic pyloric stenosis, with no obvious gastrointestinal symptoms after birth, often showing symptoms after adulthood. But there have been reports of cases in a family where both childhood and adult onset can occur. 80% of the cases are male patients, with a wide range of onset ages. In some cases, routine gastric barium meal examination found a rate of only 0.04% to 1%.

　　Second, pathogenesis

　　Pathological changes show that the pyloric muscle layer is significantly thickened to 2-4 cm, thickened in a ring or spindle shape, with irregular arrangement of the muscular fibers of the circular muscle, and edema of the mucosa and submucosal tissue may be accompanied by inflammatory changes. In some cases, local hyperplasia is caused by fibrous connective tissue replacement hyperplasia.

　　Complications may include pyloric obstruction, gastric ulcer, mucosal erosion, bleeding, cancer, and so on. There may be a foul smell and taste, dry lips and thirst, irritability and insomnia, short and red urine, constipation, red tongue with yellow fur or greasy fur, and slippery and rapid pulse. Clear the stomach and reverse the adverse. The gastrointestinal tract makes a gurgling sound, dizziness, palpitations under the heart, white slippery tongue fur, and wiry slippery pulse. Vomiting blood and hematochezia, purple or瘀斑, wiry涩脉, and other diseases.

　　There may be three types:

　　1. There may be a feeling of discomfort in the upper abdomen, with periodic vomiting from infancy,即从婴儿及儿童期有间歇性幽门功能障碍表现, intermittent pyloric dysfunction in infancy and childhood, until entering adulthood, but some primary cases may not have a history of repeated vomiting in infancy.

　　2. Upper abdominal discomfort and dyspepsia symptoms may not appear until adulthood, with pain and vomiting after eating as common symptoms.

　　3. Pyloric obstruction symptoms may appear only from middle age to old age, with a short history of ulceration, but it is progressive, can be accompanied by bleeding, and after detailed examination, the final surgery only found hypertrophy of the pyloric muscle.

　　The clinical symptoms are related to the degree of pyloric canal stenosis and the duration of the disease, and can also be asymptomatic. Symptoms generally appear in adulthood,表现为餐后上腹部饱胀不适或有餐后呕吐, vomiting after meals, with relief of upper abdominal discomfort after vomiting,呈间歇发作, intermittent episodes, and pyloric antral ulcers often accompany these symptoms. Signs and symptoms are rare, and the thickened pyloric canal is rarely palpable, and in severe cases, signs of pyloric obstruction may be present.

　　If secondary causes are involved, such as local inflammation or ulcers of the stomach, then preventing the primary disease is particularly important. Fresh refers to eating a moderate amount of fresh vegetables and fruits, fresh vegetables and fruits; light refers to eating light vegetarian food. Soft and slow: Soft refers to food such as rice, vegetables, and fish should be soft and not fried, fried, or half-cooked; slow refers to chewing food slowly and thoroughly, with abundant saliva secretion.

　　Histological examination can make an accurate diagnosis.

　　Gastroscopy and X-ray barium meal are commonly used examination methods. Gastroscopy can show changes in gastritis, pyloric antrum ulcers. When obstruction is present, the pylorus is significantly narrowed, with smooth edges. Barium meal X-ray shows a long, narrow pyloric canal with small triangular pouch-like protrusions on one or both sides of the middle segment, which can disappear after local pressure. The mucosal folds in the lumen are generally arranged longitudinally, and sometimes they are also curved irregularly. A crescent-shaped concavity appears at the base of the duodenal ampulla, which is caused by the insertion of part of the thickened pyloric ring.

　　Diet should consist mainly of light foods, which is also beneficial for the patient's physical recovery. The patient's diet should be light and easy to digest, with an emphasis on eating more vegetables and fruits, a reasonable balance of dietary intake, and ensuring adequate nutrition. In addition, patients should also avoid spicy, greasy, and cold foods.

　　1. Treatment

　　For those with mild symptoms, initial conservative medical treatment can be considered, such as the administration of antiseptic drugs, etc. In most cases, surgical exploration is required to confirm the diagnosis and provide appropriate treatment. Pyloric muscle incision has uncertain effects and is technically challenging, so it is more suitable to perform a limited gastric resection followed by a gastric jejunostomy or gastrojejunal anastomosis.

　　2. Prognosis

　　Currently, there is no relevant information. For those who still do not improve after being treated with sedatives, antispasmodics, and correcting water and electrolyte imbalances, surgical treatment should be considered. The most commonly used approach is a transverse incision in the upper right quadrant of the abdomen, where the pyloric circular muscle is longitudinally incised after laparotomy without breaking the mucosa. Then, the cut muscle ring is separated and cut, allowing the mucosa to protrude from the incision edge, thereby expanding the pyloric orifice and relieving obstruction.