Hypertrophic Pyloric Stenosis vs. Gastroesophageal Reflux
Right picture: This older infant has a gastroesophageal reflux, which is persisting into the third trimenon. The only anatomical findings is an obtuse angle of His; with reflux, a combined functional voiding disorder of the stomach may be observed not alltoo rarely. Left picture: Radiologically, a hypertrophic pyloric stenosis can be diagnosed. Although this contrast study is usually not the first work-up examination, an upper gastrointestinal contrast study may be necessary if the ulrasound displays only threshold values, or if an autochthonous or primary reflux is discussed.
In both patients an upper gastrointestinal contrast study was performed due to the leading symptom ´reccurent vomiting´. Right picture: In this 8-month-old girl only little contrast is seen in the duodenum in a turned out picture; the stomach and the distal esophagus are filled tightly with contrast, the latter forming an obtuse angle with the gastric fundus. The vomiting and bringing has been persisting since birth. Left picture: In this 5-week-old boy the stomach is filled with contrast. It seems to have several segmentations due to the intense peristalsis waves. The pyloric channel is narrow and elongated, and only the duodenal bulbus is depicted. The patient has been vomiting increasingly for a week, and is admitted to the emergency ward due to exsiccosis and the impossibility of feeding.