Chapter 26 (page 123)

The Pyloric Sphincteric Cylinder in Health and Disease

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Chapter 26 (page 123)

In their second case, during retching, there was some barium in the "antrum", separated from the main mass of barium in the stomach by an annular constriction involving both curvatures of the stomach and superficially resembling the pylorus. (Comment: The appearance in the illustration is identical to contraction of the left pyloric loop) (Chap. 13).

In their third case vomiting occurred suddenly, a radiograph being taken at that exact moment. Some barium was trapped between the contracted "proximal part of the antrum" and the closed pylorus. (Comment: The trapped barium as illustrated appears to be in the pyloric sphincteric cylinder between the right and left pyloric loops).

The following are examples of cases we observed during retching:

Case Reports

Case 26.2. M.J., female aged 29 years. Having swallowed 2 mouthfuls of barium, the patient suddenly started to retch. A film exposed at that moment showed a tightly contracted pyloric sphincteric cylinder containing longitudinal mucosal folds, with folds on its oral side bulging into the gas-distended gastric lumen (Fig. 26.2). The appearance is identical to that seen during a stage of the normal contraction of the pyloric sphincteric cylinder (Chap. 13). Afterwards retching stopped, more barium was swallowed and cyclical contractions of the cylinder became normal. No lesion was detected in the upper gastrointestinal tract.

Fig. 26.2. Case M.J. Tightly contracted pyloric sphincteric cylinder, containing longitudinal mucosal folds (straight arrow). Retropelled folds bulging into gastric lumen (curved arrows)

Case 26.3. E.W., female aged 34 years. Having swallowed 4 mouthfuls of barium in the erect position, the patient suddenly started to retch; barium had reached the pyloric aperture but had not traversed it, while some was still in the oesophagus. As soon as retching started a film was exposed. This showed contraction of the left pyloric loop with a "round" collection of barium on its aboral side, i.e. in the sphincteric cylinder (Fig. 26.3A). A segmental or systolic contraction of this collection followed, terminating in a tightly contracted cylinder containing a longitudinal mucosal fold (Fig. 26.3B); this corresponded to maximal contraction of the sphincteric cylinder. During contraction barium contained in the cylinder was propagated not into the duodenum, but in a retrograde way into the more proximal part of the stomach. When retching ceased, normal cyclical contractions of the pyloric sphincteric cylinder and gastric emptying commenced. No organic lesion was found.

A B

Fig. 26.3. A Case E.W. Contraction of left pyloric loop (curved arrow). Round collection of barium in partially contracted sphincteric cylinder (straight arrow). B Case E.W. Maximally contracted sphincteric cylinder containing a longitudinal mucosal fold (arrow).

A	B
`Fig. 26.3. A Case E.W. Contraction of left pyloric loop (curved arrow). Round collection of barium in partially contracted sphincteric cylinder (straight arrow). B Case E.W. Maximally contracted sphincteric cylinder containing a longitudinal mucosal fold (arrow).`