Pyloric Stenosis.
There is a condition which involves overgrowth of the muscular fibers in the region of the pyloris, which is distinct from the conditions previously named and must have separate treatment. The walls of the stomach may become thickened by undue development in the connective tissue, which, while it will decrease the size of the cavity, will increase the actual diameter of the organ. Another form is known as congenital hypertrophic stenosis. Those forms of stenosis which are associated with the development of disease of contiguous organs, and those due to disease either of fibrous development of the stomach walls or of thickening from gastric ulcer contiguous to the pyloris, or stenosis from the presence of cancer, are not included under this head.
Symptomatology:—Exclusive of the symptoms of the last three named conditions which are given elsewhere, there is a sensation of fulness almost universal with the taking of food, there is tenderness, a dragging sensation, pressure and later pain, nausea and vomiting. In the larger proportion of cases there is deficiency of hydrochloric acid in the gastric fluid, emaciation and diminished strength.
In congenital stenosis, the vomiting occurs about the third day of the child's life without apparent cause, is sudden, and very persistent. The vomited matter never contains bile, and the food is usually but little changed. The condition is serious, exhaustion and emaciation following rapidly, with death within a few weeks.
Treatment:—The treatment will be symptomatic, the measures being applicable which are suggested in other cases. No specific plan can be outlined. In the congenital form, if the diagnosis is made early, everything should be excluded from the stomach, if possible, and feeding be done through the rectum for a period of from ten to fourteen days, at which another effort can be made to feed through the stomach. This can be continued, if no symptoms of retention or decomposition of food appear.
