The Pyloric Sphincteric Cylinder in Health and Disease

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Chapter 23 (page 111)


It has been shown that the pyloric sphincteric cylinder is a specialized muscular region of the stomach (Chap. 3), normally lined by pyloric mucosa (Chap. 5). In the vast majority of subjects its vagal supply occurs exclusively via the hepatic branch or branches (Chap. 8). Its motility is unique (as far as the stomach is concerned) in that it contracts cyclically in a "segmental" or "systolic", rather than a peristaltic way (Chap. 13). The contractions depend on and are triggered by underlying myoelectric activity (Chap. 16). In our view any one, or a combination of these factors, may have a bearing on the pathogenesis.

The contraction of the hypertrophied musculature in IHPS closely resembles a normal maximal or near-maximal contraction of the pyloric sphincteric cylinder (Chap. 13). In the former the contraction is permanent, in the latter of a fleeting nature, occurring in cycles with a frequency of approximately 3 per minute during active gastric emptying of solids. Normally when the cylinder is fully contracted, its lumen is obliterated by closely packed longitudinal mucosal folds; barium-filling of furrows between the folds may resemble lines or strings (Chap.13). A similar appearance of the mucosa is seen in IHPS, where barium-filling of longitudinal mucosal furrows in the hypertrophied and contracted cylinder gives rise to the "string sign" (Fig. 23.0). In a sense IHPS can be looked upon as the pathological counterpart of a maximal normal, physiological contraction of the sphincteric cylinder.

Radiologically and ultrasonically the narrowing of pylorospasm resembles that of IHPS in many respects (Meuwissen and Sloof l932; Torgersen l942; Astley l952; Shopfner l964; Haran et al. l966; Swischuk l980; Blumhagen and Coombs l98l; Bowen l988), showing that pylorospasm is not limited to the pyloric ring, but involves the entire pyloric sphincteric cylinder.


  1. Astley R. The radiology of infantile pyloric stenosis. Brit J Rad l952, 25, 342-350.
  2. Belding HH, Kernohan JW. A morphologic study of the myenteric plexus and musculature of the pylorus with special reference to the changes in hypertrophic pyloric stenosis. Surg Gynaec Obstet l953, 97, 322-334.
  3. Blumhagen JD, Coombs JB. Ultrasound in the diagnosis of hypertrophic pyloric stenosis. J Clin Ultrasound l98l, 9, 289-292.
  4. Blumhagen JD, Noble HGS. Muscle thickness in hypertrophic pyloric stenosis: sonographic determination. Amer J Roentg l983, 140, 221-223.
  5. Bowen A. The vomiting infant: recent advances and unsettled issues in imaging. Radiol Clin North Amer l988, 26, 377-392.
  6. Carter CO, Powell BW. Two-generation pyloric stenosis. Lancet l954, 1, 746-748.
  7. Carver RA, Okorie M, Steiner GM, et al. Infantile hypertrophic pyloric stenosis: diagnosis from the pyloric muscle index. Clin Rad l988, 38, 625- 627.
  8. Cunningham DJ. The varying form of the stomach in man and the anthropoid ape. Trans Roy Soc Edin l906, 45, 9-47.
  9. Dodge JA. Production of duodenal ulcers and hypertrophic pyloric stenosis by administration of pentagastrin to pregnant and newborn dogs. Nature l970, 225, 284-285.
  10. Dodge JA. Genetics of hypertrophic pyloric stenosis. Clin Gastroent l973, 2, 523-538.
  11. Dodge JA, Karim AA. Induction of pyloric hypertrophy by pentagastrin. An animal model for infantile hypertrophic pyloric stenosis. Gut l976, 17, 280-284.
  12. Forssell G. Über die Beziehung der Röntgenbilder des menschlichen Magens zu seinem anatomischen Bau. Fortschr Geb Röntgenstr. 1913, Suppl 30, 1-265.
  13. Freeman L. Discussion: The management of recurrent ulcer following partial gastrectomy, by Balfour DC. Ann Surg l929, 90, 535-545.
  14. Friesen SR, Boley JO, Miller DR. The myenteric plexus of the pylorus: its early normal development and its changes in hypertrophic pyloric stenosis. Surgery l956, 39, 21-29.
  15. Friesen SR, Pearse AGE. Pathogenesis of congenital pyloric stenosis: histochemical analysis of pyloric ganglion cells. Surgery l963, 53, 604-608.
  16. Frimann-Dahl J. Über den Nachweis der sogenannten kongenitalen Pylorus-hypertrophie durch Röntgenuntersuchung. Acta Rad l935, 16, 331-334.
  17. Graif M. Itzchak Y, Avigad I, et al. The pylorus in infancy: overall sonographic assessment. Pediatr Radiol l984, 14, 14-17.
  18. Haller JO, Cohen HL. Hypertrophic pyloric stenosis: diagnosis using ultrasound. Radiology l986, 161, 335-339.
  19. Haran PJ, Darling DB, Sciammas F. The value of the double-track sign as a differentiating factor between pylorospasm and hypertrophic pyloric stenosis in infants. Radiology l966, 86, 723-725.
  20. Heinisch HM. Die sogenannte Pylorushypertrophie im Tierversuch. Klin Wochenschr l967, 45, 1251-1252.
  21. Hirschsprung H. F"lle von angeborener Pylorusstenose, beobachtet bei Säuglingen. Jahrb Kinderheil, l888, 28, 61-68.
  22. Jenkinson EL. The pyloric antrum of the stomach. Amer J Roentg Rad Ther Nucl Med l955, 73, 905-937.
  23. Jona JZ. Electron microscopic observations in infantile hypertrophic pyloric stenosis. J Pediatr Surg l978, 13, 17-20.
  24. Karim AA, Morrison JE, Parks TG. The role of pentagastrin in the production of canine hypertrophic pyloric stenosis and pyloroduodenal ulceration. Brit Journ Surg l974, 61, 327.
  25. Keet AD, Heydenrych JJ. Hiatus hernia, pyloric muscle hypertrophy and contracted pyloric segment in adults. Amer J Roentg Rad Ther Nucl Med l97l, 113, 217-228.
  26. Khamapirad T, Athey PA. Ultrasound diagnosis of hypertrophic pyloric stenosis. J Pediatr l983, 102, 23-26.
  27. McKeown T, MacMahon B. Infantile hypertrophic pyloric stenosis in parent and child. Arch Dis Child l955, 30, 497-500.
  28. Meeker CS, De Nicola RR. Hypertrophic pyloric stenosis in a newborn infant. J Pediatr l948, 33, 94-97.
  29. Meuwissen T, Sloof JP. Die roentgenologische Diagnose der kongenitalen, hypertrophischen Pylorusstenose. Acta Paediatr Scand l932, 14, l9- 48.
  30. Meuwissen T, Slooff J. Roentgen examination of pyloric canal of infants with congenital hypertrophic pyloric stenosis. Amer J Dis Child l934, 48, 1304-1315.
  31. Moazam F, Rodgers BM, Talbert JL, et al. Fasting and postprandial serum gastrin levels in infants with congenital hypertrophic pyloric stenosis. Ann Surg l978, 188, 623-625.
  32. Pilling DW. Infantile hypertrophic pyloric stenosis: a fresh approach to the diagnosis. Clin Rad l983, 34, 51-53.
  33. Rintoul JR, Kirkman NF. The myenteric plexus in infantile hypertrophic pyloric stenosis. Arch Dis Child l96l, 36, 474-480.
  34. Roberts PAL. Pathology of infantile hypertrophic pyloric stenosis. Proc Roy Soc Med l959, 52, 1022-1023.
  35. Rogers IM, Drainer IK, Moore MR, et al. Plasma gastrin in hypertrophic pyloric stenosis: a hypothesis disproved? Arch Dis Childh l975, 50, 467- 471.
  36. Runström G. On the roentgen-anatomical appearance of congenital pyloric stenosis during and after the manifest stage of the disease. Acta Paediatr Scand l939, 26, 383-433.
  37. Shopfner CE. The "pyloric tit" in hypertrophic pyloric stenosis. Amer J Roentg Rad Ther Nucl Med l964, 91, 674-679.
  38. Shuman FI, Darling DB, Fisher JH. The radiographic diagnosis of congenital hypertrophic pyloric stenosis. J Pediatr l967, 71, 70-74.
  39. Skoryna SC, Dolan HS, Gley A. Development of primary pyloric hypertrophy in adults in relation to the structure and function of the pyloric canal. Surg Gynec Obstet l959, 108, 83-92.
  40. Smith B. Disorders of the myenteric plexus (progress report). Gut 1970, 11, 271-274.
  41. Strauss S, Itzchak Y, Manor A, et al. Sonography of hypertrophic pyloric stenosis. Amer J Roentg l98l, 136, 1057-1058.
  42. Stunden RJ, Le Quesne GW, Little KET. The improved ultrasound diagnosis of hypertrophic pyloric stenosis. Pediatr Radiol l986, 16, 200-205.
  43. Swischuk LE, Heyden CK, Tyson KR. Atypical muscle hypertrophy in pyloric stenosis. Amer J Roentg l980, 134, 481-484.
  44. Swischuk LE. Radiology of the Newborn and Young Infant. Williams and Wilkins, Baltimore, 2nd ed l980, pp 364-381.
  45. Swischuk LE. . Williams and Wilkins, Baltimore, 3rd ed l989, pp 394-413.
  46. Teele RL, Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. New Eng J Med l977, 296, 1149-1150.
  47. Torgersen J. The muscular build and movements of the stomach and duodenal bulb. Acta Rad l942, Suppl 45, 1-191.
  48. Torgersen J. The developmental anatomy of the pyloric canal and the etiology of infantile pyloric stenosis. Acta Rad l949, 32, 435-438.
  49. Wilson DA, Vanhoutte JJ. The reliable sonographic diagnosis of hypertrophic pyloric stenosis. J Clin Ultrasound l984, 12, 201-204.

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