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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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CASE REPORT
Year : 2007  |  Volume : 12  |  Issue : 1  |  Page : 34-35
 

Pyloric duplication in the newborn: A rare cause of gastric outlet obstruction


Department of Pediatric Surgery, The Children's Hospital, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom

Correspondence Address:
R Fisher
Department of Pediatric Surgery, The Children's Hospital, Leicester Royal Infirmary, Leicester LE15WW
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.31089

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   Abstract 

Pyloric duplication is the rarest duplication in gastrointestinal tract. Only seven cases have been reported so far in the English literature. In most cases pre-operative diagnosis was not made. We present such a case in a 9-day-old baby, presenting with non-bilious vomiting since birth. The diagnosis was made pre-operatively by ultrasonography, which is a good investigation for pre-operative diagnosis. The case was operated successfully without opening the pyloric canal.


Keywords: Pyloric duplication, gastric outlet obstruction


How to cite this article:
Sinha C K, Nour S, Fisher R. Pyloric duplication in the newborn: A rare cause of gastric outlet obstruction. J Indian Assoc Pediatr Surg 2007;12:34-5

How to cite this URL:
Sinha C K, Nour S, Fisher R. Pyloric duplication in the newborn: A rare cause of gastric outlet obstruction. J Indian Assoc Pediatr Surg [serial online] 2007 [cited 2020 Feb 28];12:34-5. Available from: http://www.jiaps.com/text.asp?2007/12/1/34/31089



   Introduction Top


Pyloric duplication is a rare entity, constituting 2.2% of all gastric duplications.[1] Only seven cases have been reported so far in English literature.[1],[2],[3],[4],[5] We report another case of this rare anomaly, which was diagnosed pre-operatively solely by ultrasonography and managed successfully without opening the pyloric canal.


   Case Report Top


A 9-day-old, full term, normally delivered, female baby presented with a history of persistent non-bilious vomiting from birth. Antenatal scan was reported as normal. Changing of breast milk to formula feed did not alter the symptom. On examination, a 5 x 4 cm firm, non-tender mass, separate from the liver, was palpated in right upper quadrant of the abdomen. There were no other positive findings on examination. The plain X-ray abdomen showed a distended stomach. Ultrasonography delineated a cystic mass extending from the right side across the midline in close proximity to a non-dilated pylorus. The diagnosis of pyloric duplication was postulated.

Laparotomy revealed a pyloric duplication cyst of 5 x 4 x 4 cm size, obstructing but not communicating with the patent lumen of the pyloroduodenal canal [Figure - 1]. No other gastro-intestinal duplication was identified. As the cyst had a common wall with the pylorus, 7/8th of the cyst was excised after partially deflating the cyst by aspiration. The residual 1/8th of the residual mucosal coat was resected completely with bipolar cautery without damage to the underlying pyloric channel. The post-operative recovery was uneventful with feeds re-instituted and tolerated at 12 hours. Histopathology confirmed the cyst wall as pyloric in nature with no evidence of ectopic tissue.


   Discussion Top


The clinical features of pyloric duplication cyst vary according to the precise site of cyst. Besides an epigastric mass or gastric outlet obstruction, it may cause recurrent peptic ulceration, gastro-intestinal hemorrhage or hypergastrinaemia.[2],[3],[4],[5]

Surgical options should be individualized to each case. These vary from simple excision to pyloro-antrectomy. In six of the seven reported cases of pyloric duplication, the cysts have been removed after opening the pyloric canal longitudinally.[2],[3],[4],[5] The vascularity of the stomach makes it technically feasible to excise only the cyst. In this case, the pylorus was not opened and the cyst was partially (7/8th) excised with stripping out of the residual (1/8th) mucosa. The raw surface was then patched with omentum. This proposed 'closed' approach allows for a rapid post-operative recovery and the early re-institution of feeding after 12 hours as is common in the management of patients following pyloromyotomy. This alternative operative technique allows effective relief of the obstruction, removal of the cyst and prompt post-operative recovery.

 
   References Top

1.Murty TV, Bhargava RK, Rakas FS. Gastroduodenal duplications. J Pediatr Surg 1992;27:515-7.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Stephen TC, Bendon RW, Nagaraj HS, Sachdeva R. Antral duplication cyst: A cause of hypergastrinemia, Recurrent peptic ulceration and hemorrage. J Pediatr Gastroenterol Nutr 1998;26:216-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Bommen M, Singh MP. Pyloric duplication in a preterm neonate. J Pediatr Surg 1984;19:158-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Grosfeld JL, Boles ET Jr, Reiner C. Duplication of pylorus in the newborn: A rare cause of gastric outlet obstruction. J Pediatr Surg 1970;5:365-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Shah A, More B, Buick R. Pyloric duplication in a neonate: A rare entity. Pediatr Surg Int 2005;21:220-2.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]


    Figures

[Figure - 1]


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    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures

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