Chapter 37 (page 185)

The Pyloric Sphincteric Cylinder in Health and Disease

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Chapter 37 (page 185)

The following are some of the cases with radiologically recognisable abnormalities.

Case Reports

Case 37.1. D.R., 40 year old male had a long history of ethanol abuse and insulin- dependent diabetes mellitus which had been treated inadequately. For several weeks there had been dyspepsia, loss of appetite and nausea. Radiologically primary and secondary oesophageal peristaltic waves were normal. After an overnight fast the stomach contained food residues; the pyloric aperture was patent, measuring 9.0. mm in diameter (Fig. 37.1A). Gastric peristaltic waves were decreased both in frequency (i.e. less than 3 per minute) and intensity (i.e. failing to "bi-sect" the organ). The pyloric sphincteric cylinder was in a state of partial contraction most of the time (Fig. 37.1B). Cyclical contraction and relaxation of the cylinder, normally occurring at a frequency of 3 per minute (Chaps. 13, 15), was lacking. No obstructing lesion was seen at the pylorus and the duodenum appeared normal. Sonographically the gall bladder, liver, spleen and kidneys were normal; there was no ascites. The patient refused endoscopic examination.

A

B

Fig. 37.1. A,B. Case D.R. A Food residues in stomach. Pyloric aperture patent. Gastric peristaltic activity diminished. B Pyloric sphincteric cylinder (arrows) contracted most of the time.

Fig. 37.1. C-F. Case D.R. After treatment and clinical improvement. Lessened contraction of sphincteric cylinder. Some movement evident but normal cyclical activity absent. Note pancreatic calcification

Six months later, after proper diabetic control, he had improved clinically. On this occasion the stomach contained less residual food. Shallow gastric peristaltic waves were present, while the pyloric sphincteric cylinder remained partially contracted throughout the examination (Fig. 37.1C). Although this was less marked than on the previous occasion, normal cyclical activity remained absent and no maximal or complete contractions were seen. Peristaltic activity in the duodenum appeared to be decreased. Active peristaltic contractions with a fast passage of barium was noted in the jejunum. The films also showed scattered areas of calcification in the pancreas and the case was diagnosed as diabetic gastroparesis and chronic alcoholic pancreatitis.