Causes and treatment of hypertrophic pyloric obstruction

Hypertrophic pyloric obstruction can cause patients to be unable to eat normally for a long time. Severe vomiting can cause malnutrition, hypoproteinemia or anemia. The common cause of this disease is submucosal fibrosis caused by chronic ulcers.

1. Causes

Ulcers located at or near the pylorus may be caused by mucosal edema or by reflex contraction of the pyloric circular muscle caused by the ulcer. A more common cause is submucosal fibrosis caused by chronic ulcers, which forms scar stenosis. The onset or aggravation of pyloric spasm is often paroxysmal and can relieve the obstruction on its own. Mucosal edema may subside as inflammation decreases. Pyloric stenosis caused by scar contracture cannot be relieved and continues to worsen. Pylorospasm is functional, while the rest are organic diseases.

II. Treatment

Generally, patients with pyloric obstruction are not suitable for emergency surgery. If after 3 to 5 days of gastrointestinal decompression, the patient can resume eating and the condition gradually improves, it means that the factors of spasm and edema have been eliminated and the patient can continue to be observed. Repeat the barium meal examination if necessary. If decompression is ineffective, it indicates scar stenosis and surgical treatment must be taken. If there is evidence of malignancy, aggressive surgery is required.

1. Medical treatment

Correcting water loss and electrolyte imbalance is the primary issue in treating pyloric obstruction, because a large amount of gastric acid is lost and there is varying degrees of alkali poisoning. Therefore, after admission to the hospital, normal saline can be given first, and potassium chloride solution needs to be added when the urine volume increases. Patients with severe hypokalemic alkali poisoning may even need to supplement potassium chloride every day. To supplement water, use 5% to 10% glucose solution. Calculated based on the basic daily requirement of 2500 ml, plus the amount sucked out from the gastric tube every day and a portion of the water loss. Therefore, in addition to the appropriate amount of electrolyte solution according to the results of blood biochemistry tests, the insufficient water is supplemented with glucose solution. Secondly, the dilated stomach is restored by continuous decompression. The disappearance of inflammatory edema allows the tension of the gastric wall muscle layer to be restored. If the obstruction is caused by pyloric spasm or mucosal edema, after the obstruction is eliminated, the diet and corresponding medications should be adjusted according to ulcer disease.

2. Surgical treatment

Short-term medical treatment was ineffective, indicating that scar contracture was the main factor causing pyloric obstruction. Or if it is diagnosed as gastric ulcer after examination, especially if there is suspicion of malignancy, surgical treatment should be performed at a later date after the inflammatory edema disappears due to non-surgical treatment.