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Association of antral diaphragms and hypertrophic pyloric stenosis
Insights
A previously unreported association between prepyloric membrane and hypertrophic pyloric stenosis was observed in infants and a baby orangutan. This finding highlights a potential link between these conditions, impacting pediatric and comparative gastrointestinal research.
Area of Science:
- Pediatric Gastroenterology
- Comparative Pathology
Background:
- Hypertrophic pyloric stenosis (HPS) is a common cause of gastric outlet obstruction in infants.
- Prepyloric membranes are rare congenital anomalies of the gastric antrum.
Observation:
- Seven human infants and one infant orangutan presented with a concurrent diagnosis of prepyloric membrane and HPS over a two-year period.
- In human infants, HPS was the primary obstructive lesion, while the membrane caused obstruction in the orangutan.
- A case of a six-year-old patient with a history of pyloromyotomy presented with gastric retention due to an antral membrane.
Findings:
- This study reports a novel association between prepyloric membranes and HPS in both human infants and a non-human primate.
- The findings suggest that prepyloric membranes may play a role in the pathophysiology of HPS or present as an independent obstructive lesion.
- The case of the older child indicates that antral membranes can cause delayed gastric emptying and complications even after prior surgical intervention.
Implications:
- This association may necessitate a re-evaluation of diagnostic and treatment strategies for HPS, considering the potential presence of prepyloric membranes.
- Further research into the embryological development and genetic factors underlying both conditions is warranted.
- The observation in an orangutan broadens the understanding of these gastrointestinal anomalies in a comparative context, potentially offering insights into evolutionary aspects.
Abstract:
In a 2 year period at Children's Hospital of Philadelphia, seven human infants and a baby orangutan all presented with a previously unreported association of a prepyloric membrane and hypertrophic pyloric stenosis. In the humans, the pyloric stenosis was the obstructive lesion, and in the orangutan, the web. We also report a 6-year-old patient with previous pyloromyotomy who presented because of prolonged retention of a marble in the stomach by an associated antral membrane.