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PYLORIC STENOSIS A DIFFERENT APPROACH TO MANAGEMENT
Author(s) -
Duggan J. M.
Publication year - 1973
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1973.tb129782.x
Subject(s) - medicine , pyloric stenosis , pylorus , distension , gastric distension , vomiting , gastric outlet obstruction , upper gastrointestinal series , surgery , pyloric antrum , gastroenterology , stomach , antrum
A review is presented of 100 unselected adult patients admitted to hospital over a five‐year period with the syndrome of pyloric stenosis. Of these, 79% were suffering from peptic ulcer, 11% from carcinoma, and the remaining 10% from a variety of benign conditions. A personal series of 41 patients, largely patients admitted to hospital urgently with nutritional and electrolyte problems, is reviewed also. These patients were managed by a regime based upon four principles: (i) no pylorus is totally obstructed; (ii) obstruction in ulcer patients is caused by varying degrees of spasm, oedema and fibrosis; (iii) with no loss of fluid and electrolytes by gastric aspiration and vomiting, electrolyte problems are minimized; (iv) avoidance of gastric distension means the gastrin‐stimulated secretion from antral distension is minimized. The regime evolved consists of initial gastric aspiration only, and then small and increasing amounts of milk, insufficient to cause gastric distension, in combination with intravenous fluids to restore and maintain water and electrolyte homœostasis. The regime outlined leads to an ability to defer surgery until the patient's general and local condition is improved. In one‐third of patients surgery was not necessary during the index admission to hospital.