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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The infant rumination syndrome is an uncommon disorder difficult to differentiate from commoner conditions causing vomiting and weight loss. Its validity has recently been questioned. Its importance is heightened by the availability of newer diagnostic and operative procedures that might be misapplied. An 8-month-old male infant had been regurgitating for two months with increasing inanition. Results of diagnostic tests suggested pylorospasm or gastric pseudo-obstruction syndrome. Medical management failed. A therapeutic trial of special nursing eight hours a day resulted in rapid rehydration, weight gain, and avoidance of surgery. This case exemplifies each of the ten characteristics of the infant rumination syndrome.
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PMID:Infant rumination syndrome: report of a case and review of the literature. 42 42

Because it causes immediate pain when taken into the mouth, strong mineral acid is less often swallowed than corrosive alkali, but psychotic, inebriated or determined individuals may consume lethal amounts. Burns of the oropharynx and glottis may lead to asphyxial death. Acid has only superficial effects upon the esophagus but, upon reaching the stomach, flows along the lesser curvature, induces pylorospasm, and pools in the distal antrum. Pyloric stricture is the most common late complication among survivors. Due to the rapidity with which acid acts, local and systemic therapy must be expeditious. Neutralization and demulcification are recommended but no time should be lost if weak alkali is not readily available. Lavage has limited applicability and induced emesis is strictly contraindicated. Aggressive intravenous fluid therapy, antibiotics, and opiates for pain are needed in most instances. Immediate gastrectomy and steroids are controversial but operative intervention is eventually required following most significant ingestions.
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PMID:Emergency management and sequelae of acid ingestion. 65 Oct 75

Gastric outlet obstruction in infants and children may be due to a partial, prepyloric antral diaphragm. Twelve new patients are added to the 32 described previously. Onset of symptoms varied from shortly after birth to five years. Nonbilious vomiting was the most common presenting symptom. Radiographic evaluation requires specific technique for demonstration of the web and to differentiate this from pylorospasm and pyloric stenosis. Gastroscopy was employed in three patients. Repair usually consisted of incision of the web and construction of a patulous gastric outlet. All patients remained asymptomatic after operation. The etiology of the webs remains unknown, but they may result from an excessive local endodermal proliferation early in gastric development.
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PMID:Antral diaphragm--a cause of gastric outlet obstruction in infants and children. 83 Sep 10

Diabetes mellitus has been associated with a variety of gastrointestinal motor disturbances. Pyloric activity, however, has not been specifically investigated. We have quantified the pyloric manometric profile in 24 diabetics with recurrent nausea or vomiting, or both, without evidence of mechanical obstruction. Twelve healthy volunteers served as controls. A multilumen pneumohydraulic perfusion assembly with five side openings, each 1 cm apart, was positioned fluoroscopically across the antroduodenal junction and used to monitor pressure activity for 5 h (3 h fasting and 2 h fed). Three patterns of pyloric activity were defined and quantified: (a) baseline elevation of greater than or equal to 3 mmHg for greater than or equal to 1 min (tonic pattern); (b) antral-type phasic pressure activity mixed with duodenal phasic activity (phasic pattern); and (c) phasic pattern superimposed on tonic activity (combined tonic-phasic pattern). The duration of the total pyloric activity before and after the meal was greater in diabetics than in controls (p less than 0.005). Furthermore, episodes of unusually prolonged (greater than or equal to 3 min) and intense (greater than or equal to 10 mmHg) tonic contraction, "pylorospasm," were observed in 14 of 24 diabetics but in only 1 control (p = 0.025). In diabetics, episodes of pylorospasm had a peak amplitude of tonic activity of 13 +/- 1 mmHg and a duration of 7 +/- 0.7 min (mean +/- SE). We conclude that pyloric dysmotility forms part of the widespread disruption of gut motility that affects some patients with diabetes.
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PMID:Pyloric dysfunction in diabetics with recurrent nausea and vomiting. 369 9

Since 1979 nine children have undergone excision of gastroduodenal pancreatic rest. In three, these lesions were incidental findings at the time of unrelated surgery. The remaining six underwent resection for relief of abdominal symptoms. There were four boys and two girls. The ages ranged from 4 months to 13 years. Symptoms were directly related to age. Three children (6 months, 8 months and 4 years) were admitted for recalcitrant post-prandial vomiting. The remaining three (11, 12, and 13 years) were hospitalized for chronic midabdominal pain. Contrast radiographic studies were normal in three. An antral filling defect was noted in one and edematous proximal duodenum with poor peristalsis in the remaining child. Endoscopic examination and biopsy documented pancreatic rest in all six cases. All were located in the immediate vicinity of the pylorus. The size ranged from 0.5 to 2 cm in diameter. Each child subsequently underwent excision with relief of symptoms. Pancreatic rest is functioning pancreas. Its presence in the prepyloric region may incite pylorospasm, delayed emptying and gastric distention and become clinically apparent with vomiting and/or abdominal pain. Documentation of gastroduodenal pancreatic rest in the symptomatic child with an otherwise normal evaluation may warrant excision.
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PMID:Symptomatic gastroduodenal pancreatic rest in children. 648 92

Postoperative radiographic findings in the gastrointestinal tract were analyzed in 43 of 72 patients with gastric bypass for morbid obesity. In 15 patients studied because of early postoperative vomiting or abdominal pain, two showed leak from the proximal gastric pouch and six showed impairment of proximal pouch emptying at the anastomosis or proximal efferent loop. In four of the six, the impaired emptying was due to transient postoperative edema and improved spontaneously. Three patients had impairment of distal gastric pouch emptying due to pylorospasm. Five patients studied in the late postoperative period showed dehiscence of the gastric staple line, which can be difficult to demonstrate radiographically. Familiarity with the normal and the abnormal radiographic appearance after gastric bypass is important in elucidating the nature of the problems that can arise after this operation.
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PMID:Radiographic abnormalities after gastric bypass. 697 28

Sixteen infants under 11 weeks of age developed documented peptic ulcer disease involving the stomach, duodenum or pylorus during an eight-year period in a Newborn Intensive Care Unit. The precipitous onset of gastrointestinal bleeding and/or perforation commonly associated with ulcer disease in early infancy was present in only seven (44%) of the 16 patients. The remaining nine infants (56%) presented with recurrent emesis, a presentation of peptic ulcer disease rarely described in the first weeks of life. Contrast radiography was used to demonstrate a definite ulcer crate in 13 of these patients. Two had their ulcers diagnosed at surgery and one by endoscopy. Radiographic demonstration of pylorospasm and/or gastric retention was often associated with ulcer craters located in the pyloric channel or gastric antrum. Only two patients required surgery for massive bleeding and perforation. The remainder were successfully managed medically using orogastric suction antacids and gradual resumption of milk feedings. There were no deaths within our population attributable to peptic ulcer disease.
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PMID:Peptic ulcer disease in early infancy: clinical presentation and roentgenographic features. 721 60

Short segment narrowing of the pyloric canal is a common finding in infants with chronic vomiting, and most often is due to pylorospasm. In such cases, it is transient, and offers no real problem in diagnosis. On the other hand, when it persists, a question arises as to whether it is due to fixed stenosis. Differentiation of the two conditions is difficult, but important, for while spasm can be treated medically, true stenosis requires surgical intervention. Just how to accomplish this differentiation is the subject of this report, and for the most part, centers around the infant's response to a therapeutic trial of antispasmodics. Patients with pylorospasm respond favorably, while those with fixed stenosis do not. Generally, these latter patients require pyloromyotomy, but in the occasional infant, so little muscle hypertrophy is present that we have found pyloroplasty to be the preferred procedure.
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PMID:Short segment pyloric narrowing. Pylorospasm or pyloric stenosis? 725 15

This paper describes a simple and effective fluoroscopic technique that remarkably improves diagnostic accuracy when evaluating vomiting newborns. The technique also minimizes the time of the examination and the radiation dose to the patient and radiology personnel. Several examples are presented illustrating the superiority of gloved hand or nonopaque compression technique to conventional contrast radiography, emphasizing babies with pyloric stenosis and midgut malrotation. The technical limitations and diagnostic pitfalls of conventional contrast modalities are compared to the highly diagnostic images obtained with manual compression fluoroscopy. All of the classic radiographic signs of pyloric stenosis can be mimicked by antral spasm or pylorospasm. Gloved hand compression overcomes antral spasm and clearly shows the true length and diameter of the pyloric canal in these two conditions. Malposition of the duodenojejunal junction is the only consistently diagnostic sign of midgut malrotation. Nonfixation of the duodenojejunal junction can be competently assessed by compression fluoroscopy, confirming malrotation and midgut volvulus simultaneously and bringing the patient to operation much sooner than with less precise conventional techniques. Gloved hand compression technique also evaluates stenotic areas in the upper gastrointestinal tract, distinguishing spasm from organic marrowing and clearly identifying those which need surgical intervention. Facilitating intubation of the duodenum is a final contribution of compression fluoroscopy.
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PMID:Diagnostic advantages of manual compression fluoroscopy in the radiologic work-up of vomiting neonates. 738 60

We compared sonographic images and measurements of patients diagnosed as having hypertrophic pyloric stenosis and pylorospasm among infants with projectile vomiting. Thirty-seven patients with hypertrophic pyloric stenosis had an unchanged pyloric length (mean, 22.5 mm) and muscle wall thickness (mean, 5.3 mm). Thirty-four pylorospasm patients had considerable variability in measurement or image appearance during their studies. Means of their longest or largest measurements were 14.4 mm for pylorus length and 3.8 mm for muscle wall thickness. Among these, 53% had muscle wall thickness of 4 mm or greater and 18% had pyloric length of 18 mm or greater during some portion of their study. We concluded (after clinical follow-up study confirmed our ultrasonographic diagnoses) that pylorospasm may mimic hypertrophic pyloric stenosis for at least a portion of a sonographic study. Muscle wall thickness or pyloric length measurements may overlap those accepted as positive for hypertrophic pyloric stenosis. Image or measurement variability is an important clue for diagnosing pylorospasm.
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PMID:Ultrasonography of pylorospasm: findings may simulate hypertrophic pyloric stenosis. 980 7


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