Stomach and duodenum

Abstract

21.1 General considerations Hypertrophy of the pyloric muscle causes gastric outlet obstruction Incidence 1:250 live births, most common in Caucasian populations 4:1 male-to-female ratio Family history often positive, particularly sons born to affected mothers, indicating a polygenic pattern of inheritance Etiology largely unknown 21.2 Hypertrophy of the pyloric muscle causing gastric outlet obstruction is a common condition of unknown etiology. The prognosis is excellent, with definitive surgery following adequate resuscitation. 21.3 General considerations Incidence about 1:10,000 births Approximately 70% of congenital intestinal stenoses and 45% of atresias are found in the duodenal region 30% have trisomy 21 (Down's syndrome) Diagnosis is possible antenatally • 17%-57% have associated polyhydramnios • Antenatal ultrasonography may identify a dilated stomach and proximal duodenum (double-bubble) • Antenatal diagnosis should prompt a detailed search for associated anomalies and amniocentesis The majority of cases are diagnosed in the early newborn period Other associated anomalies include: • Congenital heart disease ( 20%) • Malrotation ( 20%) • Esophageal atresia and tracheo-esophageal fistula ( 20%) • Genito-urinary anomalies ( 9%) • Anorectal anomalies ( 3%) • VACTERL association (vertebral abnormalities, anal atresia, cardiac abnormalities, tracheoesophageal fistula and/or esophageal atresia, renal agenesis and dysplasia and limb defects) © 2009 Springer-Verlag.