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Hypertrophic Pyloric Stenosis in the Adult

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Abstract

AN ADULT FORM of hypertrophic pyloric stenosis has been recognized since 1835, when Jean Cruveilhier1 first reported the case of a 72-year-old woman who presented a lifelong history of dyspepsia and vomiting. Although this disease has received far less attention than its more common pediatric counterpart, reports of cases have continued to appear sporadically since that time. Few authors have failed to express themselves on the fundamental issue of whether the disease entity is congenital or acquired. This report has been prepared not only in order to add one more case to the literature, but also in the hope that a summation of available data may provide sufficient information reasonably to resolve this central problem of etiology.

Historical Review

In 1885, Maier2 described 35 cases discovered at autopsy. Judd and Thompson3 in 1933 reported 20 cases confirmed at laparotomy during a ten-year period. In 11 of these the diagnosis was confirmed histologically. In the same year, Kirklin and Harris4 reported 81 cases in which they believed that a roentgenographic diagnosis of the disease entity had been established; in 31 of their patients there was no other gastrointestinal abnormality. However, their contention that the roentgenographic finding of a crescentic indentation of the duodenal bulb with prepyloric narrowing was pathognomonic was not supported by the findings of Bockus5 and other observers, and is not widely accepted today. Other authors whose contributions were concerned with smaller series of five cases or less include McClure,6 Crohn,7 Katz,8 Wakefield,9 Berk and Dunlap,10 and Greenfield.11

Clinical . . .


 

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