Chapter 35 (page 178)

The Pyloric Sphincteric Cylinder in Health and Disease

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Chapter 35 (page 178)

Case 35.2M.B., 59 year old female presented with dysphagia. Oesophagoscopy and biopsy revealed a poorly differentiated squamous cell carcinoma of the oesophagus at 26.0cm. Radiography confirmed the lesion, which appeared to extend to just above the cardia. There was constant contraction of the pyloric sphincteric cylinder, which appeared to be "fixed" midway between maximum contraction and relaxation, with absent cyclical activity; this caused the pyloric aperture to remain widely patent (Fig. 35.2). Laparotomy for staging the oesophageal carcinoma revealed metastatic lymphadenopathy at the coeliac axis; the stomach appeared normal, showing that the contraction of the sphincteric cylinder was of a functional nature.

Fig. 35.2. Case M.B. Double contrast examination. Constant contraction of pyloric sphincteric cylinder with absent cyclical activity. Pyloric aperture patent.

Case 35.3 M.A., female aged 50 years, presented with dysphagia of one year's duration. Radiographic examination showed a carcinoma 5.0 cm in length in the lower oesophagus. There was marked contraction or spasm of the entire pyloric sphincteric cylinder, with a prominent pseudo-diverticulum on its greater curvature side (Fig. 35.3). Occasionally a minor degree of movement was seen; most of the time the appearance remained as indicated. Subsequent oesophagoscopies confirmed carcinomatous involvement of the lower third of the oesophagus.

Fig. 35.3. Case M.A. Constant, near maximal contraction of pyloric sphincteric cylinder with pseudo-diverticulum on greater curvature side.

Case 35.4V.M., male aged 38 years. Radiographic examination showed constant irregularity and narrowing of the lower 4.0 cm of the oesophagus, extending through the hiatus to the gastro-oesophageal junction (Fig. 35.4). The diagnosis of carcinoma was confirmed by oesophagoscopy. Constant contraction of the pyloric sphincteric cylinder, similar to that of the previous cases, was present.

Fig. 35.4. Case V.M. Carcinoma lower oesophagus, extending through hiatus in diaphragm (arrow).