Details

Pyloric stenosis following duodenal ulceration

GC.10730

Stomach. Pyloric stenosis following duodenal ulceration. From a male aged 42 years. Onset of symptoms 1940 when a duodenal ulcer was demonstrated by X-ray, There was periodic dyspepsia until 1945 when he had a haematemesis. Further haematemesis occurred in 1954. Seven months before operation he began to complain of severe flatulence and sensations of fulness in the abdomen. On only one occasion has he had any retention vomiting and that was two weeks before the operation. He did, however, have a marked succession splash when seen prior to operation. At operation, as well as the marked gastric distension, there were anterior and posterior duodenal ulcers with a small inflammatory mass. The condition was treated by subtotal gastrectomy. The specimen consists of the distal 3/4th of the stomach and pylorus removed at operation. The anterior wall of the stomach has been removed. There is gross dilatation of the organ and the wall is stretched and thinned. The pyloric canal is very markedly stenosed and permits only the passage of a 3 mm. rod. The mucosa on the gastric side of the canal is roughened and scarred as the result of previous ulceration - only a very small portion of normal duodenal mucosa is visible. The gastric mucosa is stretched and all the rugae have been lost. The mucosa is atrophic ant congested throughout. Photomicrograph - The flattened character of the mucosa is demonstrated and the stretched atrophic muscle clearly seen.

Twentieth century