pyloric obstruction and gastric dilatation

pyloric obstruction and gastric dilatation

Blockage of the lower orifice of the stomach with consequent hypertrophy and dilatation of the stomach. Pyloric obstruction increases the resistance offered to the expulsion of food from the stomach. The causes of dilatation are pyloric obstruction per se (secondary to peptic ulcer, tumor, idiopathic hypertrophy), laxness of walls from simple atony, or excessive ingestion of food or drink. Additional causes of acute gastric dilitation include certain infections (such as pneumonia) and postoperative states with gastric atony and spasm of the pylorus.


The typical findings are dyspepsia, vomiting (occasionally projectile vomiting), wasting, and dehydration. Vomiting may occur long after eating, sometimes several hours or days. Constipation is present. There is bulging over the epigastrium. In thin subjects, the outline of the stomach may be visible. Palpation gives a splashing fremitus. In percussion there is an increased area of gastric tympany. In auscultation, splashing sounds often are audible at some distance.


In acute obstruction, treatment includes nasogastric decompression of the stomach with parenteral fluid administration and gradual resumption of oral feeding. In chronic obstruction (congenital, neoplastic, inflammatory), surgery is indicated.


Outcome relates to cause and promptness of treatment. It is generally favorable in cases of acute dilatation without obstruction.