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Chapter 25 (page 120)
Aron et al. (l973) described the case of an elderly female in whom radiographic
examination showed an hiatus hernia and a large filling defect on the lesser curvature side
of the "distal antrum" with narrowing of the antral outlet. Endoscopy revealed
oesophagitis while an irregular submucosal lesion measuring 2.5 cm x 0.5 cm was seen
approximately l.0 to 2.0 cm proximal to the pylorus on the lesser curvature side; biopsy
showed a normal mucosa. At operation a localized, firm, nodular mass measuring 3.0 cm
in length and extending from the pylorus to the "distal antrum" on the lesser curvature,
was found. Histology revealed marked hypertrophy of the circular musculature,
diagnosed as torus hyperplasia which had presented as a gastric pseudotumor.
Liebermann-Meffert and Allgöwer (l977) investigated the morphology of the
pylorus and "antrum" in gastric ulcer disease. In a series of 77 cases the ulcer was
adjacent to the pylorus in 10, and in other parts of the stomach in 67. Focal areas of
muscle hypertrophy which distorted either the "antrum", the pyloric ring or both were
commonly found. The hypertrophy was not uniform but irregular, involving different
parts of the pylorus and "antrum" to a variable degree. The findings were not described
in detail nor interpreted in the light of the anatomy as determined by Cunningham (1906),
Forssell (1913) and Torgersen (1942).
At least 27 cases of focal hypertrophy (including one of focal spasm) of the pyloric
musculature in adults have been described in detail in the literature. Seventeen were not
associated with other lesions in the upper gastrointestinal tract and apparently occurred de
novo. Four cases were associated with chronic or atrophic gastritis (one also had achylia
gastrica), one with an acute erosion, 2 with hiatus hernia, 2 with gastric and one with
In 17 cases the hypertrophy (or spasm in one case) was limited to the pyloric muscle
torus or knot. (The l7 cases in this group do not tally with the l7 mentioned above).
Normally contraction of the pyloric muscle knot is a fleeting occurrence, being part of
cyclical contraction of the sphincteric cylinder; it causes an evanescent widening of the
lesser curvature part of the pyloric ring (Chap. 13). In focal hypertrophy of the muscle
knot the mass occurs in the same situation and is permanent. The condition may be
considered to be the pathological counterpart of a physiological stage of contraction.
Radiographically Seaman (l966) noted a permanent widening of the lesser curvature side
of the pyloric ring in 2 of his 4 cases of torus hyperplasia. In retrospect this was also
present in our Case 25.1. A similar but very advanced case was described by Aron et al.
(l973). Torus hyperplasia should be considered in the radiological differential diagnosis
of permanent widening of the lesser curvature side of the pyloric ring.
In 7 of the remaining l0 cases (described by Bachmann) the focal hypertrophy, while not
strictly limited to the
muscle torus, occurred in the same region and can probably be explained on the same
basis. In 3 the hypertrophy occurred elsewhere in the pyloric musculature; this also
applied to the cases of Liebermann-Meffert and Allgöwer (l977), which were not
It is concluded that focal hypertrophy is limited to the pyloric muscle torus in many
instances, but this is not invariably the case and it may also occur elsewhere in the pyloric
musculature. It may occur de novo or be associated with gastric ulceration (located more
proximally in the stomach), chronic or erosive gastritis, hiatus hernia and duodenal
ulceration. Whether it represents an early stage of diffuse adult hypertrophic pyloric
stenosis is not known.
- Aron JM, Newman A, Heaton JW. Torus hyperplasia of the pyloric antrum
presenting as a gastric pseudotumor. Gastroenterology l973, 64, 634
- Bachmann KD. Über umschriebene, plattenförmige
Muskelhyperplasien im Antrum und Pylorus ("Muskelplatten"), Beitr path
Anat l952, 112, 97 - 103.
- Cunningham DJ. The varying form of the stomach in man and the anthropoid
ape. Trans Roy Soc Edin l906, 45, 9 - 47.
- Forssell G. Über die Beziehung der Röntgenbilder des menschlichen
Magens zu seinem anatomischen Bau. Fortschr Geb Röntgenstr
1913, Suppl 30, 1 - 265.
- Heidenblut A. Herdförmige gutartige Pylorushypertrophie des
Erwachsenen. Fortschr Geb Röntgenstr Nuklearmed 1961, 94,
l75 - 181.
- Keet AD. Focal hypertrophy of the pyloric musculature in adults. Arch
Path l956, 61, 20 - 23.
- Knight CD. Hypertrophic pyloric stenosis in the adult. Ann Surg
l96l, 153, 899 - 910.
- Liebermann-Meffert D, Allgöwer M. The morphology of the antrum and
pylorus in gastric ulcer disease. Prog Surg 1977, 15, 109 - 139.
- Mack HC. Adult hypertrophic pyloric stenosis. Arch Int Med 1959,
104, 574 - 579.
- Seaman WB. Hypertrophy of the pyloric muscle in adults.
Radiology l963, 80, 753 - 764.
- Seaman WB. Focal hypertrophy of the pyloric muscle: torus hyperplasia.
Amer J Roentg Rad Ther Nucl Med l966, 96, 388 - 392.
- 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
Gynaec Obstet l959, 108, 83 - 92.
- Torgersen J. The muscular build and movements of the stomach and duodenal
bulb. Acta Rad l942, Suppl 45, 1 - 191.
- Wellman KF, Kagan A, Fang H. Hypertrophic pyloric stenosis in adults: survey
of the literature and report of a case of the localized form (torus hyperplasia).
Gastroenterology l964, 46, 601 - 608.
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