PYLORIC STENOSIS This eondition is traceable to arrests of development or inflammatory processes in fetal life and frequently assumes the form of complete atre.sia. As early as in the first days of existence it leads to a pronounced symptomatic picture of a more or less complete intestinal oeclusion and, after a short time, to death, which, according to our present experience, could not be avoided either by operative or conservative treatment. This group also includes the extremely- rare eases of congenital malignant tumor of the pylorus.
According to Wernstedt the pylorus stenosis of Landerer-Maier, which Hirschsprung erroneously connected with hypertrophie stenosis, is a congenital deformity which chiefly consists in an abnormally- small diameter of the gastric outlet. This rare formation, however, does not apparently cause any symptoms in infants.
For purposes of differential diagnosis, passage obstacles with unfavorable prognosis in the upper digestive tract, before or behind the pylorus, call for consideration. They occur either at the (esophagus,
where they cause regurgitation of all ingesta (examination by the sound), or at the duodenum above or immediately below the papilla. The duodenum may also be compressed by a floating kidney-, an enlarged pancreas head, or an abnormally situated arteria mesenterica superior.
The signs of congenital eicatricial and eonnective-tissue stenosis may be similar to Hirschsprung's type, but its intensity is very rapidly increased and nearly always leads to severe prostration and death within a few days.
Vomiting of bile is very characteristic for infrapapillar atresia of the duodenum. The fact that in suprapapillar atresia the visible peri stalsis extends to the duodenum, cannot be exploited as a mark of distinction, since this may also occur in hypertrophic stenosis, progressive peristaltic waves extending into the hypochondrium in otherwise typical cases of Hirschsprung's stenosis, according to Cautley and the author.