Hypertrophic Pyloric Stenosis

Adult Form:

The adult form of hypertrophic pyloric stenosis is usually secondary to a mild, unrecognized infantile form resulting in intermittent nausea and vomiting. Acute obstructive symptoms are uncommon and the condition may go undiagnosed for years. A majority of patients have associated PUD due to prolonged gastrin production secondary to stasis and decreased gastric emptying. An UGIS is usually performed, rather than US, given a broader differential for nonspecific presenting symptoms. Medical management with proton pump inhibitors and diet modification is the most common treatment; however, pyloromyotomy may be indicated for more severe cases.

UGIS Findings:

• Narrowing and elongation (2-4 cm) of the pyloric canal

• Benign antral ulcer (present in 74% of patients)

• "Shouldering" caused by the hypertrophied pylorus indenting upon the duodenal bulb

Single contrast UGIS. The pylorus demonstrates abnormal filling defects and delayed passage of contrast.

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A spot film of the pylorus from the above study shows:

• Narrowing and elongation of the pyloric canal
• A central collection of pooled contrast consistent with ulceration
• Intrusion of the hypertrophied pylorus into the duodenal bulb ("shouldering")

Don't be confused by the superimposed portion of small bowel.