Chapter 24 (page 115)

The Pyloric Sphincteric Cylinder in Health and Disease

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Chapter 24 (page 115)

Discussion

Most authors agree that adult hypertrophic pyloric stenosis (AHPS) is a rare condition. In approximately 17,000 upper gastrointestinal barium examinations over a 5 year period we diagnosed the condition not more than 3 or 4 times; these patients were lost to follow-up and the diagnosis could not be verified.

Types of AHPS

Primary, Idiopathic or Simple

AHPS may occur in the absence of other pathology in the upper gastrointestinal tract. An analysis of 129 verified cases encountered in the literature, showed that 51 had no associated lesions (Table 24.1). In addition to the above Morton (1930) described 3, North and Johnson (1950) 5, Lumsden and Truelove (1958) 5, Christiansen and Grantham (l962) 2, and Larsen et al. (l967) one case of verified AHPS without concomitant lesions. (These were individual cases, not forming part of larger groups). These cases have been termed primary (North and Johnson l950), idiopathic (Edwards l96l) or simple (Keynes l965) AHPS. In order to differentiate the condition from focal hypertrophic pyloric stenosis Skoryna et al. (l959) designated them cases of diffuse primary pyloric hypertrophy without associated proximal gastric lesions.

Table 24.1. Analysis of 129 verified cases of AHPS encountered in the literature


Authors	No. of verified AHPS cases	No. of AHPS cases without associated lesions

Kirklin & Harris (1933)	50	15
Desmond & Swynnerton (1957)	25	6
Craver (1957)	11	5
McNaught (1957)	5	3
Skoryna et al. (1959)	6	2
Knight (1961)	3	2
Keynes (1965)	12	6
Bateson et al. (1969)	17	12

TOTAL	129	51

AHPS: adult hypertrophic pyloric stenosis

Secondary or Complicated

Associated or concomitant lesions in the upper gastrointestinal tract were present in 78 of 129 verified cases of AHPS. In attempting to determine the nature and incidence of the associated lesions, it would have been useful to analyze the figures in Table I; however, this was not possible as the relevant particulars were not given in all instances. A separate series of case reports (some of which did not include cases of primary AHPS) was analyzed to obtain the particulars; this is shown in Table 24.2, in which 81 of 119 cases of AHPS had associated lesions. (Some cases had more than one associated lesion, e.g. gastric ulcer and gastritis. "Other" includes conditions such as previous gastric ulceration, prolapse of gastric mucosa and pyloric adhesions).

Table 24.2. Associated lesions in AHPS


Authors	No. of verified AHPS cases	Associated lesions

		Gastric ulcer	Duodenal ulcer	Pyloric ulcer	Gastritis	Hiatus hernia	Other

Desmond & Swynnerton (1957)	25	12	6	1	-	-	-
Craver (1957)	11	3	2	-	1	-	-
McNaught (1957)	5	2	-	-	-	-	-
Skoryna et al. (1959)	6	1	-	1	-	-	2
Knight (1961)	3	1	-	-	-	-	-
Seaman (1963)	27	18	2	-	5	-	2
Keynes (1965)	12	2	3	1	-	-	-
du Plessis (1966)	2	2	-	-	2	-	-
Boden & Haake (1968)	11	-	-	-	-	11	-
Bateson et al. (1969)	17	4	-	1	-	-	-

TOTAL	119	45	13	4	8	11	4

AHPS: adult hypertrophic pyloric stenosis

Where the condition was associated with other lesions it was termed secondary (North and Johnson l950; Edwards l96l) or complicated AHPS (Keynes l965). In order to differentiate these cases from focal hypertrophic pyloric stenosis Skoryna et al (l959) called them diffuse primary pyloric hypertrophy associated with a proximal gastric lesion. Du Plessis (l966) termed the condition primary hypertrophic pyloric stenosis commencing in adult life without apparent cause.