What is the pylorus?
The pylorus is the sphincter located at the end of the stomach, at its transition with the duodenum. With the stomach’s contraction movements, the pylorus opens and allows the stomach content to pass into the duodenum.
Pyloric stenosis
Pyloric stenosis is the partial or total narrowing of the pylorus that prevents the progression of the stomach content to the duodenum.
Pyloric stenosis can occur due to 3 main causes:
1- Hypertrophic pyloric stenosis: a condition that occurs in some newborns where the muscle of the sphincter becomes very “tight” and prevents the stomach content from passing into the intestine. In these cases, children have vomiting crises and become malnourished. The resolution of this problem is done by surgery through the pyloroplasty procedure.
2- Stomach tumors: some stomach tumors can grow to the point of causing obstruction of the pylorus, preventing the progression of the stomach content. In these cases, surgery is usually performed to remove the affected part of the stomach. In very advanced cases, an expandable stent can be passed through endoscopy for decompression.
In some cases where stent placement is not possible, the gastric bypass procedure is performed, connecting the stomach to the intestine.
3- Benign stenosis: some ulcers of the stomach or pylorus can, when healing, lead to retraction of the organ wall and closure of the pylorus. In these cases, endoscopic dilation of the region with a hydrostatic balloon type is performed.
In cases where there is no improvement with the dilations, surgical treatment of the problem is performed.
Complications
Pyloric dilation is generally performed effectively and without problems. Some complications that may occur are:
- A small amount of bleeding almost always occurs when the dilation is performed. If this bleeding is excessive, it may require more aggressive treatment.
- Another complication is perforation (a hole in the organ wall). If this happens, an operation may be necessary to repair the problem.
- Rarely, a small perforation can lead to infection, which can remain localized or even spread to neighboring organs.
Residência em Endoscopia Digestiva no Hospital das Clínicas da USP (HCFMUSP)
Residência em Gastroenterologia no Hospital Universitário da UFSC
Presidente da SOBED / SC na gestão 2018-2020
Médico da clínica Endogastro em Florianópolis e ProGastro em Joinville