Gastric Outlet Obstruction in an infant · Gastric Outlet Obstruction in an infant Sophia L Fu, MD . Richmond University Medical Center. Staten Island, NY. SUNY Downstate Medical

Gastric Outlet Obstruction in an infantSophia L Fu, MD

Richmond University Medical CenterStaten Island, NY

SUNY Downstate Medical Center, Brooklyn, NY

January 20, 2010

downstatesurgery.org

History 14 mo male with intermittent nonbilious, nonprojectile,

nonbloody vomiting, ~30min-2hrs s/p feeding, 3 lb wt loss

in 2 mo, no ↓ appetite, ↓ stool & wet diapers

PMH: BW 6lbs 7oz, NICU stay x2mo 2º withdrawal Sx;

4day stay for RSV @6mo

FHx: maternal drug addiction

SocHx: FT, NSVD, older sister, immunizations

Gastric Outlet Obstructiondownstatesurgery.org

Physical Examination VS 98º 125/83 149 24

Wt 20.2lbs (3-10%) Ht 27.5in (<3%)

Gen: irritable, non-consolable, eager to eat/drink

HEENT: NCAT, MM dry

Cv: nl S1 S2, RRR, no m/r/g

Chest: CTAB/L

Abd: soft, NT, ND, no mass, +BS

Skin: warm, dry, good turgor, good cap refill


Laboratory work-upGastric Outlet Obstruction

134

2.1

80.3

38.9

13

0.213020.7

14.3

40.7583

10.7

UA – neg7.3

5.1

49

19

213

1.1


Abdominal X-rayPyloro-antral Web downstatesurgery.org

UltrasoundGastric Outlet Obstruction

Impression – Highly Suspicious for Pyloric Stenosis


Initial Management & Endoscopy

Resuscitation

D5 ¼ NS +20mEq KCl @80

NGT placement

GI Consult

Peds Surgery Consult


Upper GI SeriesGastric Outlet Obstructiondownstatesurgery.org

Surgical ExplorationGastric Outlet Obstructiondownstatesurgery.org

PathologyGastric Outlet Obstruction

Antral Web


Operative Management/ Recovery Transverse upper abdominal incision

Gastrotomy – web resection

14Fr Bougie fit

Total OR time: 2:10

EBL minimal

D5 1/3NS180mL

Parathyroid Adenoma

POST-OP recovery

Await BM

Advance diet

D/C Home POD#4


Pyloro-antral Web


Etiology Maternal intrauterine vascular

accidents

Ischemic necrosis

Subsequent bowel atresia

Failure of recanalization

Redundancy and slipping of

epithelial lining

Genetics

Pyloroduodenal obstruction

Pyloro-antral Web downstatesurgery.org

Clinical Presentation Maternal Hx of polyhydramnios

Nonbilious vomiting

Gastric outlet obstruction

Respiratory Sx

Dyspnea

Tachypnea

Cyanosis

Excessive salivation

Epigastric fullness

Perforation


Abdominal RadiographyPyloro-antral Web downstatesurgery.org

Upper GI SeriesPyloro-antral Web downstatesurgery.org

PathologyPyloro-antral Web downstatesurgery.org

Surgery


Treatment of Pyloric Atresia Gastrotomy

Distal passage of a catheter

Detect membranous obstructions

Excision of complete or partial diaphragm

Heineke-Mikulicz or Finney Pyloroplasty

Gastroduodenostomy

Alternative procedures using endoscopy

Balloon dilatation

Laser web excision

Laser radial incisions of membrane


References• Balaji NS, Peters JH: Minimally invasive surgery for esophageal motility disorders. Surg Clin North Am 82:763–

82, 2002.• Brace M, Taylor SM, Trites JR, Bethune D, Attia E, Hart RD. Endoscopic stapling versus external

transcervical approach for the treatment of Zenker diverticulum. J Otolaryngol Head Neck Surg. 2010 Feb 1;39(1):102-6.

• Bremner CG, DeMeester TR: Endoscopic treatment of Zenker's diverticulum. Gastrointest Endosc49:126–8, 1999.

• Sen P, Bhattacharyya AK: Endoscopic stapling of pharyngeal pouch. J Laryngol Otol 118:601–6, 2004.• Sohn H. J, DeMeester S. R, "Chapter 25. Resection of Esophageal Diverticula" (Chapter). Sugarbaker DJ, Bueno

R, Krasna MJ, Mentzer SJ, Zellos L: Adult Chest Surgery: http://www.accesssurgery.com/content.aspx?aID=5287346.

• Souba W, Fink M( \Jurkovich G, \Kaiser L, Pearce W, Pemberton J, Soper N. ACS Surgery: Principles and Practice 2010.

• Zollinger RM Jr, Zollinger RM Sr, "Zenker's Diverticulectomy" (Chapter). Zollinger RM Jr, Zollinger RM Sr: Zollinger's Atlas of Surgical Operations, 8th Edition: http://www.accesssurgery.com/content.aspx?aID=61515.

Zenker’s Diverticulumdownstatesurgery.org

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Brace%20M%22%5BAuthor%5D�

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Taylor%20SM%22%5BAuthor%5D�

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Trites%20JR%22%5BAuthor%5D�

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bethune%20D%22%5BAuthor%5D�

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Attia%20E%22%5BAuthor%5D�

http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hart%20RD%22%5BAuthor%5D�

http://www.amazon.com/s/ref=ntt_athr_dp_sr_1?_encoding=UTF8&sort=relevancerank&search-alias=books&field-author=Wiley%20W.%20Souba�

http://www.amazon.com/s/ref=ntt_athr_dp_sr_2?_encoding=UTF8&sort=relevancerank&search-alias=books&field-author=Mitchell%20P.%20Fink�

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Gastric Outlet Obstruction in an infant · Gastric Outlet Obstruction in an infant Sophia L Fu, MD . Richmond University Medical Center. Staten Island, NY. SUNY Downstate Medical