Cases reported "Pyloric Stenosis"

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1/10. An uncommon association of H-type tracheoesophageal fistula with infantile hypertrophic pyloric stenosis.

    Although infantile hypertrophic pyloric stenosis following esophageal atresia repair is known, infantile hypertrophic pyloric stenosis following H-type tracheoesophageal fistula has not been encountered previously. A case of H-type tracheoesophageal fistula and infantile hypertrophic pyloric stenosis is presented. The patient, operated on for H-type fistula, a rare congenital anomaly of the esophagus, on the tenth day of life was readmitted 19 days later because of continuous vomiting after every feeding. The clinical findings and physical and radiological examinations revealed infantile hypertrophic pyloric stenosis which required surgical treatment. It is suggested that the association of H-type tracheoesophageal fistula with infantile hypertrophic pyloric stenosis is coincidental, given the estimated incidence of one in every 84,375,000 males and 337,500,000 females.
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keywords = esophagus
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2/10. Spontaneous esophageal perforation related to a duodenal ulcer with pyloric stenosis: report of a case.

    This report describes a case of spontaneous esophageal perforation that was considered to be etiologically related to a duodenal ulcer with pyloric stenosis. The patient was a 54-year-old Japanese man who presented following the sudden onset of severe abdominal pain and dyspnea after an episode of vomiting. He had a history of duodenal ulcer. Computed tomography revealed an extremely dilated stomach containing abundant food residue, intraabdominal effusion, bilateral pleural effusion, and mediastinal emphysema, findings that strongly suggested esophageal perforation. esophagoscopy confirmed perforation of the lower esophagus. laparotomy revealed marked contamination, including food residue in the abdominal cavity, and a severely dilated stomach attributed to pyloric stenosis caused by a duodenal ulcer. A 2-cm longitudinal perforation was found on the right side of the lower esophagus. Because the patient's general condition was too poor to tolerate a one-stage operation (primary closure of the perforation, gastrectomy, and reconstruction), we initially performed decompression gastrostomy and control of the esophageal leakage with T-tube placement. Following the T-tube was removed 1 month later, distal gastrectomy and reconstruction of the gastrojejunostomy (Billroth II method) could be safely performed.
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keywords = esophagus
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3/10. Acute pyloric spasm and gastric hypomotility: an extracardiac adverse effect of percutaneous radiofrequency ablation for atrial fibrillation.

    OBJECTIVES: This study sought to describe a new adverse effect of percutaneous radiofrequency (RF) ablation for atrial fibrillation (AF). BACKGROUND: Extension of the RF lesion beyond atrial myocardium may affect mediastinal structures other than the esophagus. methods: Circular mapping-guided isolation of the pulmonary veins was performed in two different electrophysiology laboratories, either individually and supplemented by ostial and posterior left atrial (LA) ablation or two by two with a series of ostial and posterior LA lesions. The RF energy was delivered point by point through a 5-mm open-tip irrigated catheter (40 W maximum) or an 8-mm-tip catheter (45 W maximum). RESULTS: In four (two in each electrophysiology laboratory) of 367 patients undergoing catheter ablation for AF, abdominal pain and distension developed within 48 h after the procedure. Investigation showed acute pyloric spasm and gastric hypomotility, probably the result of LA endocardially delivered RF affecting the periesophageal vagi. Complete spontaneous recovery occurred in two patients, but laparoscopic esophagojejunal anastomosis and endoscopic intra-pyloric Botulinum toxin injection, respectively, were performed to remedy delayed gastric emptying in two patients. CONCLUSIONS: Thermal injury during endocardial LA RF energy delivery may extend into the mediastinum and rarely may involve the periesophageal nerves, resulting in a syndrome of acute delayed gastric emptying. Marked anatomic variability of periesophageal vagi renders it difficult to reliably avoid the area overlying this plexus, therefore, we advocate a reduction in maximum RF power and application duration on all of the posterior LA to try to avoid this complication.
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keywords = esophagus
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4/10. Membranous atresia of esophagus associated with pyloric stenosis.

    Membranous atresia of the esophagus without tracheoesophageal fistula (TEF) is very rare, only four cases have been reported since 1928. We present a case in whom a thick membrane was present 2 cm proximal to the diaphragm. The membrane was resected and the longitudinal esophagotomy wound was closed transversely. The postoperative course was complicated with hyperbilirubinemia and hypertrophic pyloric stenosis (HPS). The problems of the feeding tube used for diagnostic evaluation of this rare esophageal anomaly are discussed. In spite of its low incidence, the potentiality of HPS as a cause of postoperative vomiting in esophageal atresia should be borne in mind in order to avoid delay in diagnosis.
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ranking = 5
keywords = esophagus
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5/10. Corticosteroids in treatment of obstructive lesions of chronic granulomatous disease.

    Two patients with chronic granulomatous disease had obstructive lesions of the gastrointestinal tract, esophagus, and genitourinary tract, which were successfully treated with corticosteroids. These obstructive lesions, caused by local granuloma formation, have been reported in 18 other patients with chronic granulomatous disease, none of whom received steroids. Our first patient, a 3-year-old boy, had emesis and weight loss associated with antral narrowing and delayed gastric emptying at age 2 years. Antibiotic therapy was ineffective, but intravenous and oral corticosteroid therapy for 10 weeks resulted in clinical cure. One year later, dysuria associated with bladder neck obstruction was also treated successfully with corticosteroids. The second child, a 10-year-old boy, had dysphagia caused by distal esophageal stenosis. Corticosteroid therapy (with concomitant antibiotics) on two occasions reversed this obstruction. Granulomatous cystitis with ureteropelvic obstruction then developed, which also responded to treatment with corticosteroids and antibiotics. Despite the risk of increased susceptibility to infection, corticosteroid therapy is justified in preventing life-threatening obstruction of vital organs.
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keywords = esophagus
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6/10. Development of infantile hypertrophic pyloric stenosis in patients treated for oesophageal atresia. A case report.

    Two cases of infantile hypertrophic pyloric stenosis (IHPS) developed in 74 patients treated for oesophageal atresia. Treatment of oesophageal atresia is frequently followed by vomiting and failure to thrive due to gastrooesophageal reflux or anastomotic stricture. The diagnose of IHPS must be considered in such patients under the age of 8 weeks as symptoms of IHPS are similar to those of gastrooesophageal reflux. The diagnose of IHPS is strongly supported by the presence of a non-carbonic alkalosis. Contrast studies including oesophagus, stomach and duodenum are to be made early in the course, as clinical signs of IHPS are often masked.
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keywords = esophagus
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7/10. Complete obstruction of the gastric antrum in children following acid ingestion.

    We report on two children who experienced delayed complete obstruction of the gastric antrum following concentrated acid ingestion. Both patients required initial tube gastrostomy and subsequent antrectomy with intestinal reconstruction. Unlike the more common alkaline corrosives, ingested acids tend to spare the esophagus and gastric fundus. While gastric perforation and vascular collapse may occur immediately following overwhelming acid ingestion, the more common course is chronic gastric antral inflammation with subsequent fibrosis and, in some cases, complete stricture. Delayed surgical reconstruction is recommended to permit the acute inflammation and edema to subside.
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keywords = esophagus
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8/10. Hydrostatic balloon catheters. A new dimension of therapeutic endoscopy.

    Disorders secondary to strictures of various segments of the gastrointestinal tract, e.g. esophagus, stomach, bile ducts, pancreas and colon often produce symptoms requiring continuing medical management or aggressive intervention. Until now, surgery has been required for failures of medical treatment. Endoscopically placed balloon catheters offer an alternative method for effectively treating a variety of gastrointestinal strictures. In this report we present examples of applications of balloon catheters in clinical gastroenterology.
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keywords = esophagus
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9/10. Eosinophilic gastroenteritis with esophageal involvement.

    Eosinophilic gastroenteritis is an unusual disease entity characterized by eosinophilic infiltration of the gut with gastrointestinal disturbance. The disease commonly involves the stomach and small bowel. Esophageal involvement is rarely reported. We present a patient with simultaneous achalasia, pyloric stenosis, and ascites. Macroscopically, the esophagus, stomach and small intestine were involved. Microscopically, the mucosa was involved to the serosa. The patient has remained well under low dose prednisolone treatment for 7 years since his condition was diagnosed.
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keywords = esophagus
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10/10. The diffuse hypertrophy of the lower esophagus and the focal hypertrophy of the pyloric musculature in adults.

    The diffuse hypertrophy of the lower esophagus is a hypertrophy and hyperplasia of the smooth muscle fibres of the M. propria, together with a distortion of the muscular architecture. The esophagogram reveals an impaired peristalsis and expansile ability of the esophagus lumen. The focal hypertrophy of the pyloric musculature in adults is a locally circumscribed hypertrophy and hyperplasia of the M. propria. The concentric pattern of the M. propria is no longer maintained. Radiologically one recognizes a benign pylorus stenosis with a complete systole and an impaired diastolic dilatation. On the basis of these macroscopical, microscopical and radiological findings both lesions differ from the circular pyloric or esophageal stenosis which occurs at the same anatomical sites. We therefore feel, that both lesions are different entities.
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ranking = 6
keywords = esophagus
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