Congenital Narrowness of the Pyloric Orifice a cause of Chronic Gastric Disease in the Adult, Illustrated by Seven Cases Successfully Treated by Operation
Authors: A. E. Maylard
Journal: BMJ (1904)

CONGENITAt N&RuwNESS OF PYLORUS.FEB 26, t9o4.pancreatic fistula remained for several months.Health and weight fully regained.In October, I903, reported to be quite well.CASE XII.-July, igor; female, aged 28.Had six years' history of increasing indigestion, dating from an illness described by the doctor as " ulcerated stomach."Pain comes on one hour after food, worse when lying on the right side.Vomits after nearly every meal.Is getting steadily thinner.Signs I, 2, 3, 4, 5, 6, and 7 all present.At the operation an hour-glass stomach was found and very tight pyloric obstruction.Gastroplasty and posterior gastro-enterostomy into the distal pouch.The patient died.The patient was seen by Dr. Baxter- Tyrie of Keighley.Death from pneumonia on the fifth day.The anaesthetic was badly taken, lividity and rigidity of abdominal muscles being present throughout.CASE xiii.-April22nd, 1902; female, aged 42.Has had chronic indigestion.The symptoms came on gradually-pain after food, vomiting, and constipation.Eighteen months ago had haematemesis, and since then the symptoms have been greatly increased.Signs x, 2, 3, 8, and 6 present, and a diagnosis of hour-glass stomach made.At the operation an hour-glass stomach (a perfect example) was found.The constriction in the body admitted the little finger snugly.In the narrowed isthmus, on the posterior surface, a densely hard indurated area, at least J in. in thickness; the lesser and greater omenta both puckered up.Gastroplasty-a scar of the ulcer seen on mucous surface of posterior part.A very tight stricture found at the pylorus, the pyloric pouch being dilated also.Posterior gastro-enterostomy from pyloric pouch.The patient recovered.The patient was sent by Dr. H. H. Greenwood.A very rapid pulse for-four days after operation.Report in October, 1903 :-" Quite well; six months pregnant."CASE xiv.-November 2gth, 1902; female, aged 27.Nine years' his- tory.Pain after food and vomiting were the symptoms first noticed.Soon all solid food caused pain, and was rejected.The food became " sour," and the gas belched up smelt putrid.On several occasions blood has been vomited.The signs and symptoms of hour-glass stomach were elicited, and a confident diagnosis made.The two pouches of an hour-glass could be distinctly seen on inflation.Signs x, 2, 3, 5, and 6 present, and an hour-glass stomach diagnosed.At the operation an hour-glass stomach was at once exposed, but on tracing the stomach up to the cardiac orifice another stricture and another pouch were found.There were thus two annular constrictions in the stomach and three pouches6 The first pouch was the largest, the pyloric tie smallest, being only of the size of a lemon.Gastro-gastrostomy and gastro-enterostomy were performed.The stomach was scarred almost universally.The patient recovered.The patient was sent by Dr. Knowles, Newstead, Halifax.She made a most excellent recovery.In October, 1903, she had gained xi st.. and was taking food well.CASE xv.-January 20th, 2903; female, aged 34.Nine and a-half years ago vomited a " great deal " of blood.Dr. Mackenzie then dia- gnosed ulceration of the stomach.Since then has always been ailing, especially after a moderate meal.Five years ago was very ill; had acute abdominal pain, severe vomiting, and haematemesis.Was in Manchester Royal Infirmary with " ulcer of the stomach."'One year and a-half ago had haematemesis.For several years has taken no solid food, and has never had an ordinary meal.Has lived on milk, custards, porridge.On examination an hour-glass stomach was diagnosed.