Pediatric surgery. Prepyloric gastric obstruction. Clinic (most important)

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Pediatric surgery. Prepyloric gastric obstruction. Clinic (most important)

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34. Prepyloric obstruction of the stomach. Clinic

Malformations of the stomach, localized in its prepyloric section, are an extremely rare pathology. Violation of the patency of the stomach usually cause atresia and stenosis.

According to the classification, there are three main variants of gastric anomalies: membranous, cord-like and segmental aplasia of the mucosa. With all types of atresia and stenosis of the stomach, the obstruction is localized only in the mucous and submucosal layers, the muscular and serous membranes retain their continuity.

The membrane can close the lumen of the stomach completely (atresia) or partially (stenosis), having holes of various sizes on the side or in the center of the septum: from a pinpoint to a large one, occupying more than half of the membrane. The thickness of the latter ranges from a thin sheet to a thick folded "hypertrophied" wall protruding into the pyloric canal of the stomach.

Histological examination of the membranes reveals an altered gastric mucosa with a submucosal layer and muscle tissue in the form of single fibers. The thick septum has the structure of the wall of the stomach.

clinical picture. Prepyloric gastric atresia and decompensated stenosis usually appear from the first hours or days of life. The main symptom is profuse vomiting of gastric contents without bile. Due to overdistension of the stomach and irritation of its walls from frequent vomiting, a “hemorrhagic symptom” is often associated (vomit the color of coffee grounds or streaked with blood and a tarry coloration of the stool.

Frequent, vomiting usually leads to exsicosis with a large drop in body weight (0,25-0,3 kg per day). On examination, swelling of the epigastric region is revealed, which disappears after vomiting or suction of gastric contents. On palpation, waves of peristalsis and the contours of a distended stomach are visible, often descending below the navel.

X-ray examination. X-ray examination is one of the main diagnostic methods. Plain x-ray of the abdominal cavity in a vertical position shows a large gas bubble and a liquid level corresponding to a distended stomach; there is no gas in the intestinal loops.

Prepyloric stenosis may appear days or weeks after the baby is born. The time of onset of symptoms depends on the size of the hole in the membrane. The disease begins with regurgitation without an admixture of bile, turning into vomiting. Soon, vomiting takes on the character of vomiting "fountain". Decreased body weight. The chair becomes more scarce. On examination, swelling of the epigastric region and visible peristalsis of the distended stomach are revealed.

Plain radiographs of the abdominal cavity with the child in an upright position show a large level of fluid in the stomach and a small amount of gas in the bowel loops. In such cases, a contrast study with iodolipol is undertaken.

Authors: Drozdov A.A., Drozdova M.V.

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