PMC5906761_01
CT abdomen pelvis showing thickening of the distal gastric antrum (yellow arrow). Full color available online.
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CT abdomen pelvis showed thickening of the distal gastric antrum (Figure 1).
Endoscopy showing (a) 300 ml of residual oatmeal (b) & (c) Pylorus demonstrating 'cervix sign' (d) Serial Balloon Dilator being inserted into the small pylorus opening.
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A stenotic pylorus was found, which was dilated to 15 mm (Figures 2, 3). At this time, our main differential diagnosis included AIHPS, peptic ulcer disease, malignancy, and Gastrointestinal stromal tumors (GISTs).
Endoscopy showing (a) Serial Balloon Dilator serially expanding the stenotic pyloric opening from 12 mm to 15 mm with bloody response; (b) on withdrawal after dilation a split defect of at least 5 mm is seen.
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A stenotic pylorus was found, which was dilated to 15 mm (Figures 2, 3). At this time, our main differential diagnosis included AIHPS, peptic ulcer disease, malignancy, and Gastrointestinal stromal tumors (GISTs).
Cross section of the pylorus showing (a) increased thickness of the pylorus muscle, (b) focally hyperplastic gastric muscularis propria (c) 10x magnification and hyperplastic muscularis layer reaching up to the lamina propria.
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There was no evidence of surface gastric metaplasia or increased numbers of polymorphonuclear leukocytes (Figure 4).