Lee Riah S, Dygulski Sylvia, Hemida Yasmine, Uy Guillermo M
Surgery, Touro College of Osteopathic Medicine, Middletown, USA.
General Surgery, Garnet Health Medical Center, Middletown, USA.
Cureus. 2025 May 29;17(5):e85037. doi: 10.7759/cureus.85037. eCollection 2025 May.
Adult hypertrophic pyloric stenosis (AHPS) is a rare subtype of gastric outlet obstruction (GOO) that occurs without a history of recurrent vomiting or other gastrointestinal symptoms in infancy. AHPS type 2 is the most common type of AHPS that arises from underlying GI pathologies such as recurrent peptic ulcer disease (PUD), malignancy, vagal hyperactivity, and extrinsic adhesions. A 43-year-old male with no history of vomiting in infancy presented with a two-day history of intractable nausea, nonbilious and non-bloody forceful vomiting, globus pharyngeus, and worsening dysphagia to both solids and liquids. The patient had experienced similar episodes in the past, all of which were managed conservatively. The computed tomography (CT) of the abdomen/pelvis with IV contrast showed marked distention of the stomach, unable to rule out GOO. Esophagogastroduodenoscopy (EGD) revealed multiple clean-based ulcers with a pinhole-sized opening at the pylorus, making it difficult to pass. A robotic distal gastrectomy with Roux-en-Y reconstruction was subsequently performed without major complications. The pathological examination of the specimen showed focal, moderate, nonspecific chronic inflammation but was negative for , acute inflammation, granuloma, dysplasia, or tumor. The recovery was uneventful, and the patient was discharged without any complications. With history, physical examination, and radiography often failing to provide definitive results, fiberoptic gastroscopy with histopathological examination is a more reliable diagnostic tool. While nonsurgical management, such as proton-pump inhibitors, has shown mild efficacy in treatment, partial gastrectomy remains the definitive surgical approach for symptomatic AHPS. AHPS is a rare cause of gastric outlet obstruction in adults, and diagnosis is based upon radiological and endoscopic findings after excluding other common causes of GOO. We emphasize the importance of including AHPS in the differential diagnosis for patients presenting with globus pharyngeus and dysphagia.
成人肥厚性幽门狭窄（AHPS）是胃出口梗阻（GOO）的一种罕见亚型，在婴儿期无反复呕吐或其他胃肠道症状病史的情况下发生。AHPS 2型是最常见的AHPS类型，由潜在的胃肠道疾病引起，如复发性消化性溃疡病（PUD）、恶性肿瘤、迷走神经功能亢进和外在粘连。一名43岁男性，婴儿期无呕吐史，出现了两天的顽固性恶心、非胆汁性和非血性强力呕吐、咽部异物感以及固体和液体吞咽困难加重。患者过去曾经历过类似发作，均经保守治疗。腹部/盆腔增强计算机断层扫描（CT）显示胃明显扩张，无法排除GOO。食管胃十二指肠镜检查（EGD）显示多个基底干净的溃疡，幽门处有针孔大小的开口，难以通过。随后进行了机器人辅助远端胃切除术并 Roux-en-Y 重建，无重大并发症。标本的病理检查显示局灶性、中度、非特异性慢性炎症，但急性炎症、肉芽肿、发育异常或肿瘤均为阴性。恢复顺利，患者无并发症出院。由于病史、体格检查和影像学检查往往无法提供明确结果，纤维胃镜检查及组织病理学检查是更可靠的诊断工具。虽然非手术治疗，如质子泵抑制剂，在治疗中显示出轻微疗效，但部分胃切除术仍然是有症状的AHPS的确定性手术方法。AHPS是成人胃出口梗阻的罕见原因，诊断基于排除其他常见GOO原因后的影像学和内镜检查结果。我们强调在对有咽部异物感和吞咽困难的患者进行鉴别诊断时纳入AHPS的重要性。
