Pyloric stenosis in its adult forms (2)

My life’s work as a church pastor has made me aware of many of the common medical conditions, as I have supported people with all kinds of cancers, many heart, lung and “lower abdominal” conditions… ah, I don’t want to bore you with the long list!

Troublesome and also serious medical conditions often occur without warning and they can totally surprise the sufferer.  When I needed two kinds of eye surgery some years ago, I already knew a lot about the cause, the procedure, and the likely outcome.  My father had already charted my path, as had several people I pastored. 112

But most non-medical people have not had not worked with as many sick people as I have, and many health problems don’t have a clear family / genetic factor.  For these folk especially it can be very frustrating to be dealing with something life-affecting they know nothing about; quite likely they’d never heard of their condition before.

Adult pyloric stenosis (“PS”) is often like that: it is far rarer than the infant form (which itself is not exactly everyday), and it’s not always obviously linked with the family’s genes or the patient’s lifestyle.

A 1998 medical report deals with such a case.  For the details, please use the link to find and read the full article.  All three medical journal reports mentioned in this post are commendably available free and in full on the web! Points of general interest in this first article include –

  • It concerns a (then) 47 year old Caucasian woman, a rare thing as PS in both its infant and adult forms affects about 4 times as many males as females.
  • It seems this PS case was regarded as “primary” – without an obvious cause.  Several symptoms started only some 2 – 3 months before her surgery, and although she had suffered from dyspepsia and occasional vomitting she had none of the common precursors to adult PS: infant PS, adhesions, a gastric ulcer or cancer (which would have made this a “secondary PS”).
  • Examinations and imaging before her surgery showed little abnormality apart from reduced stomach emptying, but post-op pathology showed abnormal cell and muscle structure in the pyloric region.
  • The distal gastrectomy surgery involved removing the lower part of the stomach and the pylorus and attaching the stomach to the duodenum.
  • The report tells us there were no continuing symptoms, although it is not hard to find less concise and straightforward comments from other patients elsewhere!  This patient had severe surgery that should be expected to change digestive functioning.

Several other matters are also worth mentioning –

  • It is mentioned at several points that the cause of primary adult PS is little understood, and it is claimed that there are no statistics on how frequently it occurs.
  • Several surgical techniques are used to manage adult PS, all of which are more radical and affect digestion far more than Ramstedt’s operation which is the usual procedure used to remedy infant PS.

In light of this, I was somewhat intrigued to discover that a 1965 article (also freely available in full) contradicted several of the most significant assertions made by the previous report!  Specifically, Dr Milo W Keynes claimed that –

  • “Primary”, “uncomplicated” or “simple” PS in adults seems to have a genetic base.
  • It is far more common than is often claimed – but adult PS patients and those with a “simple” PS are less likely to seek treatment than the parents of a very sick baby.
  • “Secondary” PS occurs more often than the “primary” form, although reports of the incidence vary greatly from 10:1 to 3:1.
  • Many of the patients had struggled with symptoms for many years (e.g., 12 years), and sometimes from childhood.
  • There is a long list of symptoms, and these vary greatly.
  • Most patients were older, but the documented cases ranged from age 14 to 85.
  • Adult PS occurs in about 2 males to every female – different from the infant form.
  • It is claimed that “simple” PS can usually be traced to the patient’s infancy.
  • It is also claimed that it can be managed without major surgery: by the same muscle-splitting Ramstedt operation as done with babies.
  • However, at the end of the article it is stated that the preferred management of adult PS is by one of the much more severe surgical techniques, so that underlying disease such as a cancer or an ulcer can be dealt with if necessary and because the Ramstedt procedure does not always relieve the obstruction.  This leaves the patient and surgeon with a choice between gastro-duodenostomy, gastroenterostomy, gastro-jejunostomy, partial gastrectomy and pyloroplasty.

Another article in the same medical journal issue as the previous one reported on a study of 100 adult PS patients, all of whom had their diagnosis confirmed at surgery.  All but 3 of these were found to have a cancer or peptic ulcer(s): of these 3, one had Hodgkin’s disease, leaving the other two with a “simple” adult hypertrophic (enlarged) PS. Details in this report which are likely to be of interest to the reader of this blog include –

  • Although the symptoms of adult PS vary greatly, the core symptoms are common and quite unmistakable: vomiting containing food eaten a day or two earlier, loss of appetite, weight loss, and gastric splash (an audible sloshing sound in the stomach when rocked more than 3 hours after a meal).
  • A duodenal ulcer can cause obstruction without vomiting.

These two reviews of informative articles conclude a series of three on adult PS.

Interested readers might use the “Categories” box (top right of the “page”) to find other posts on this subject. DiscussionForum

Facebook members might join one or more of the largest PS Groups on this social web forum, as some 12 adult PS sufferers have shared something of their varied and common experience of this condition.  Several of these Groups are “closed”: all can be found via the Facebook Search box, but to encourage candid sharing only those who join can see their contents.

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