Skip to main content

Advertisement

SpringerLink
Log in

Usual and unusual causes of pediatric gastric outlet obstruction

  • Pictorial Essay
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Gastric outlet obstruction in children encompasses a spectrum of disorders that extends beyond hypertrophic pyloric stenosis. Each condition can result in the clinical syndrome of persistent nonbilious vomiting, which can progress to dehydration and electrolyte imbalances. This paper reviews the spectrum of both the common and uncommon entities that cause partial or complete gastric outlet obstruction and their imaging appearances. The correct diagnosis of those with gastric outlet obstruction can be achieved by combining clinical presentation with appropriate imaging, leading to optimal and timely patient management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16

Similar content being viewed by others

References

  1. Siegel NJ, Carpenter TO, Gaudio KM (1999) Pathophysiology of body fluids. In: McMillan JA, DeAngelis CD, Feigin RD et al (eds) Oski’s pediatrics principles and practice. Lippincott Williams & Wilkins, Philadelphia, pp 67–85

    Google Scholar 

  2. Milla PJ (1992) Gastric-outlet obstruction in children. N Engl J Med 327:558–560

    Article  PubMed  CAS  Google Scholar 

  3. Cremin BJ (1967) Neonatal pre-pyloric membrane. S Afr Med J 41:1076–1079

    PubMed  CAS  Google Scholar 

  4. Feng J, Gu W, Li M et al (2005) Rare causes of gastric outlet obstruction in children. Pediatr Surg Int 21:635–640

    Article  PubMed  Google Scholar 

  5. Sharma KK, Ranka P, Goyal P et al (2008) Gastric outlet obstruction in children: an overview with report of Jodhpur disease and Sharma’s classification. J Pediatr Surg 43:1891–1897

    Article  PubMed  Google Scholar 

  6. McElvoy CF (1999) Developmental disorders of gastrointestinal function. In: McMillan JA, DeAngelis CD, Feigin RD et al (eds) Oski's pediatrics principles and practice. Lippincott Williams & Wilkins, Philadelphia, pp 309–315

    Google Scholar 

  7. Vade A, Jafri SZ, Agha FP et al (1983) Radiologic evaluation of gastrostomy complications. AJR 141:325–330

    PubMed  CAS  Google Scholar 

  8. Yen JB, Kong MS (2006) Gastric outlet obstruction in pediatric patients. Chang Gung Med J 29:401–405

    Article  PubMed  Google Scholar 

  9. Schechter R, Torfs CP, Bateson TF (1997) The epidemiology of infantile hypertrophic pyloric stenosis. Paediatr Perinat Epidemiol 11:407–427

    Article  PubMed  CAS  Google Scholar 

  10. Wang J, Waller DK, Hwang LY et al (2008) Prevalence of infantile hypertrophic pyloric stenosis in Texas, 1999-2002. Birth Defects Res A Clin Mol Teratol 82:763–767

    Article  PubMed  CAS  Google Scholar 

  11. MacMahon B (2006) The continuing enigma of pyloric stenosis of infancy: a review. Epidemiology 17:195–201

    Article  PubMed  Google Scholar 

  12. Panteli C (2009) New insights into the pathogenesis of infantile pyloric stenosis. Pediatr Surg Int 25:1043–1052

    Article  PubMed  Google Scholar 

  13. Krogh C, Fischer TK, Skotte L et al (2010) Familial aggregation and heritability of pyloric stenosis. JAMA 303:2393–2399

    Article  PubMed  CAS  Google Scholar 

  14. Chung E, Curtis D, Chen G et al (1996) Genetic evidence for the neuronal nitric oxide synthase gene (NOS1) as a susceptibility locus for infantile pyloric stenosis. Am J Hum Genet 58:363–370

    PubMed  CAS  Google Scholar 

  15. Carter CO, Evans KA (1969) Inheritance of congenital pyloric stenosis. J Med Genet 6:233–254

    Article  PubMed  CAS  Google Scholar 

  16. Langer JC, Berezin I, Daniel EE (1995) Hypertrophic pyloric stenosis: ultrastructural abnormalities of enteric nerves and the interstitial cells of Cajal. J Pediatr Surg 30:1535–1543

    Article  PubMed  CAS  Google Scholar 

  17. Okazaki T, Yamataka A, Fujiwara T et al (1994) Abnormal distribution of nerve terminals in infantile hypertrophic pyloric stenosis. J Pediatr Surg 29:655–658

    Article  PubMed  CAS  Google Scholar 

  18. Dick AC, Ardill J, Potts SR et al (2001) Gastrin, somatostatin and infantile hypertrophic pyloric stenosis. Acta Paediatr 90:879–882

    Article  PubMed  CAS  Google Scholar 

  19. Vanderwinden JM, Mailleux P, Schiffmann SN et al (1992) Nitric oxide synthase activity in infantile hypertrophic pyloric stenosis. N Engl J Med 327:511–515

    Article  PubMed  CAS  Google Scholar 

  20. Hernanz-Schulman M (2009) Pyloric stenosis: role of imaging. Pediatr Radiol 39(Suppl 2):S134–S139

    Article  PubMed  Google Scholar 

  21. Macdessi J, Oates RK (1993) Clinical diagnosis of pyloric stenosis: a declining art. BMJ 306:553–555

    Article  PubMed  CAS  Google Scholar 

  22. White MC, Langer JC, Don S et al (1998) Sensitivity and cost minimization analysis of radiology versus olive palpation for the diagnosis of hypertrophic pyloric stenosis. J Pediatr Surg 33:913–917

    Article  PubMed  CAS  Google Scholar 

  23. Hernanz-Schulman M (2003) Infantile hypertrophic pyloric stenosis. Radiology 227:319–331

    Article  PubMed  Google Scholar 

  24. Shuman FI, Darling DB, Fisher JH (1967) The radiographic diagnosis of congenital hypertrophic pyloric stenosis. J Pediatr 71:70–74

    Article  PubMed  CAS  Google Scholar 

  25. O’Keeffe FN, Stansberry SD, Swischuk LE et al (1991) Antropyloric muscle thickness at US in infants: what is normal? Radiology 178:827–830

    PubMed  Google Scholar 

  26. Chau B, Dufel S (2007) Gastric volvulus. Emerg Med J 24:446–447

    Article  PubMed  Google Scholar 

  27. Cribbs RK, Gow KW, Wulkan ML (2008) Gastric volvulus in infants and children. Pediatrics 122:e752–e762

    Article  PubMed  Google Scholar 

  28. Rashid F, Thangarajah T, Mulvey D et al (2010) A review article on gastric volvulus: a challenge to diagnosis and management. Int J Surg 8:18–24

    Article  PubMed  CAS  Google Scholar 

  29. Shivanand G, Seema S, Srivastava DN et al (2003) Gastric volvulus: acute and chronic presentation. Clin Imaging 27:265–268

    Article  PubMed  Google Scholar 

  30. Al-Salem AH (2007) Acute and chronic gastric volvulus in infants and children: who should be treated surgically? Pediatr Surg Int 23:1095–1099

    Article  PubMed  Google Scholar 

  31. Oh SK, Han BK, Levin TL et al (2008) Gastric volvulus in children: the twists and turns of an unusual entity. Pediatr Radiol 38:297–304

    Article  PubMed  Google Scholar 

  32. Teague WJ, Ackroyd R, Watson DI et al (2000) Changing patterns in the management of gastric volvulus over 14 years. Br J Surg 87:358–361

    Article  PubMed  CAS  Google Scholar 

  33. Johnson GM (1971) Gastric mucosal diaphragm in a child. Pediatrics 47:916–919

    PubMed  CAS  Google Scholar 

  34. Campbell DP, Vanhoutte JJ, Smith EI (1973) Partially obstructing antral web—a distinct clinical entity. J Pediatr Surg 8:723–728

    Article  PubMed  CAS  Google Scholar 

  35. Lui KW, Wong HF, Wan YL et al (2000) Antral web—a rare cause of vomiting in children. Pediatr Surg Int 16:424–425

    Article  PubMed  CAS  Google Scholar 

  36. Bell MJ, Ternberg JL, Keating JP et al (1978) Prepyloric gastric antral web: a puzzling epidemic. J Pediatr Surg 13:307–313

    Article  PubMed  CAS  Google Scholar 

  37. Woolley MM, Gwinn JL, Mares A (1974) Congenital partial gastric antral obstruction, an elusive cause of abdominal pain and vomiting. Ann Surg 180:265–273

    Article  PubMed  CAS  Google Scholar 

  38. Nissan A, Seror D, Udassin R (1997) Gastric outlet obstruction caused by prepyloric mucosal diaphragm mimicking duodenal ulcer: a case report. Acta Paediatr 86:116–118

    Article  PubMed  CAS  Google Scholar 

  39. Macpherson RI (1993) Gastrointestinal tract duplications: clinical, pathologic, etiologic, and radiologic considerations. Radiographics 13:1063–1080

    PubMed  CAS  Google Scholar 

  40. Yang DM, Kim HC, Choi SI et al (2011) Sonographic diagnosis of gastric duplication cyst communicating with the gastric lumen. J Clin Ultrasound 39:550–552

    Article  PubMed  Google Scholar 

  41. Master V, Woods RH, Morris LL et al (2004) Gastric duplication cyst causing gastric outlet obstruction. Pediatr Radiol 34:574–576

    Article  PubMed  Google Scholar 

  42. Brooks GS, Frost ES, Wesselhoeft C (1992) Prolapsed hyperplastic gastric polyp causing gastric outlet obstruction, hypergastrinemia and hematemesis in an infant. J Pediatr Surg 27:1537–1538

    Article  PubMed  CAS  Google Scholar 

  43. Wang LC, Lee HC, Yeung CY et al (2009) Gastrointestinal polyps in children. Pediatr Neonatol 50:196–201

    Article  PubMed  Google Scholar 

  44. Parikh M, Kelley B, Rendon G et al (2010) Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2:242–246

    Article  PubMed  Google Scholar 

  45. Gencosmanoglu R, Sen-Oran E, Kurtkaya-Yapicier O et al (2003) Antral hyperplastic polyp causing intermittent gastric outlet obstruction: case report. BMC Gastroenterol 3:16

    Article  PubMed  Google Scholar 

  46. Arellano CM, Kritsaneepaiboon S, Lee EY (2011) CT imaging findings of malignant neoplasms arising in the epigastric region in children. Clin Imaging 35:10–20

    Article  PubMed  Google Scholar 

  47. Benesch M, Leuschner I, Wardelmann E et al (2011) Gastrointestinal stromal tumours in children and young adults: a clinicopathologic series with long-term follow-up from the database of the Cooperative Weichteilsarkom Studiengruppe (CWS). Eur J Cancer 47:1692–1698

    Article  PubMed  Google Scholar 

  48. Kaemmer DA, Otto J, Lassay L et al (2009) The gist of literature on pediatric GIST: review of clinical presentation. J Pediatr Hematol Oncol 31:108–112

    Article  PubMed  CAS  Google Scholar 

  49. Cairo MS, Grosfeld JL, Weetman RM (1981) Gastric teratoma: unusual cause for bleeding of the upper gastrointestinal tract in the newborn. Pediatrics 67:721–724

    PubMed  CAS  Google Scholar 

  50. Gamanagatti S, Kandpal H (2007) Gastric teratoma. Singapore Med J 48:e99–e101

    PubMed  CAS  Google Scholar 

  51. Kuriyama M, Kato J, Morimoto N et al (2008) Specific gastroduodenoscopic findings in Crohn’s disease: comparison with findings in patients with ulcerative colitis and gastroesophageal reflux disease. Dig Liver Dis 40:468–475

    Article  PubMed  CAS  Google Scholar 

  52. Reynolds HL, Stellato TA (2001) Crohn’s disease of the foregut. Surg Clin North Am 81:117–135, viii

    Article  PubMed  Google Scholar 

  53. Farman J, Faegenburg D, Dallemand S et al (1975) Crohn's disease of the stomach: the ‘ram's horn’ sign. AJR Radium Ther Nucl Med 123:242–251

    CAS  Google Scholar 

  54. Parr B (1819) The London medical dictionary: including, under distinct heads, every branch of medicine, viz. anatomy, physiology, and pathology, the practice of physic and surgery, therapeutics and materia medica; with whatever relates to medicine in natural philosophy, chemistry, and natural history. London

  55. Forbes D (1858) A dictionary Hindustani and English accompanied by a reversed dictionary, English and Hindustani. Allen, William H & Co, London

    Google Scholar 

  56. Gorter RR, Kneepkens CM, Mattens EC et al (2010) Management of trichobezoar: case report and literature review. Pediatr Surg Int 26:457–463

    Article  PubMed  CAS  Google Scholar 

  57. Bège T, Desjeux A, Coquet-Reinier B et al (2011) The rapunzel syndrome: a hard-to-swallow tale. J Gastrointest Surg 15:1486–1487

    Article  PubMed  Google Scholar 

  58. Taylor JR, Streetman DS, Castle SS (1998) Medication bezoars: a literature review and report of a case. Ann Pharmacother 32:940–946

    Article  PubMed  CAS  Google Scholar 

  59. DuBose TM, Southgate WM, Hill JG (2001) Lactobezoars: a patient series and literature review. Clin Pediatr (Phila) 40:603–606

    Article  Google Scholar 

  60. Schrag SP, Sharma R, Jaik NP et al (2007) Complications related to percutaneous endoscopic gastrostomy (PEG) tubes .A comprehensive clinical review. J Gastrointestin Liver Dis 16:407–418

    PubMed  Google Scholar 

  61. Saavedra H, Losek JD, Shanley L et al (2009) Gastrostomy tube-related complaints in the pediatric emergency department: identifying opportunities for improvement. Pediatr Emerg Care 25:728–732

    Article  PubMed  Google Scholar 

  62. Haws EB, Sieber WK, Kiesewetter WB (1966) Complications of tube gastrostomy in infants and children. 15-year review of 240 cases. Ann Surg 164:284–290

    Article  PubMed  CAS  Google Scholar 

  63. Huff JP, Rosenblum J, Camara DS (1988) Complications of gastrostomy. South Med J 81:1050–1052

    Article  PubMed  CAS  Google Scholar 

  64. Fox VL, Abel SD, Malas S et al (1997) Complications following percutaneous endoscopic gastrostomy and subsequent catheter replacement in children and young adults. Gastrointest Endosc 45(1):64–71

    Article  PubMed  CAS  Google Scholar 

  65. Strouse PJ (2004) Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol 34:837–851

    Article  PubMed  Google Scholar 

  66. Applegate KE (2009) Evidence-based diagnosis of malrotation and volvulus. Pediatr Radiol 39(Suppl 2):S161–S163

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Washington Medical Center, Seattle, WA, USA

    Jeffrey P. Otjen

  2. Department of Radiology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA

    Jeffrey P. Otjen, Ramesh S. Iyer, Grace S. Phillips & Marguerite T. Parisi

Authors
  1. Jeffrey P. Otjen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ramesh S. Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Grace S. Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marguerite T. Parisi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ramesh S. Iyer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Otjen, J.P., Iyer, R.S., Phillips, G.S. et al. Usual and unusual causes of pediatric gastric outlet obstruction. Pediatr Radiol 42, 728–737 (2012). https://doi.org/10.1007/s00247-012-2375-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-012-2375-5

Keywords

Search

Navigation