López-Hernández P, Castañeda-Córdova AK

Language: Spanish
References: 10
Page: 118-124
PDF size: 337.22 Kb.

ABSTRACT

Jodhpur disease was first described in 1997, in Jodhpur, India, in pediatric patients with pyloric obstruction in which an anatomical or histopathological cause of such obstruction could not be explained; performing a theory with the presence of a probable failure in neuromuscular coordination at this level, which causes a functional obstruction at the pyloric level, without finding such a condition in the rest of the digestive tract. The objective of this study is to describe the study protocol and the surgical management of the atypical presentation of pyloric obstruction or Jodhpur disease in pediatric patients (over two years of age), in a second level hospital, in addition to evaluating the prognosis and follow-up of patients. Pyloric obstruction that occurs outside the first two months of life is considered atypical and is also rare, we present three cases of patients aged between two and six years of age, at the Hospital Infantil de Morelia between October 2018 and April 2019. In these patients, we did not find an apparent congenital or acquired anatomical obstruction, only a slight increase in the mucosal folds. However, these patients had evidence of pyloric obstruction and therefore malnutrition. All patients underwent an open surgical procedure with insertion in the supraumbilical midline, the pylorus was identified and insidiously inserted longitudinally, reviewing the pyloric layers and performing wide pyloroplasties of the Heineke Mikulicz type, with wall closure by planes, and subsequently maintained with nasogastric tube and fasting for five days, with the beginning of the oral route which gradually progressed monitoring the tolerance, were managed with prokinetic and inhibitor of the proton pump. Maintaining vigilance, until now with improvement of growth without complications.

REFERENCES

1. Fernández EJ, Salgado E, Teyssier G. Enfermedad de Jodhpur. An Med Asoc Med Hosp ABC. 2015; 60 (1): 49-52.

2. Otjen JP, Iyer RS, Phillips GS, Parisi MT. Usual and unusual causes of pediatric gastric outlet obstruction. Pediatr Radiol. 2012; 42: 728-737.

3. Aguirre B, Asz-Sigall J, Medina F, Santos K. Obstrucción pilórica inusual en pediatría informe de seis casos operados. Acta Pediatr Mex. 2013; 34 (1): 28-32.

4. Traversaro M, Cornet PS. Estenosis hipertrófica del píloro. En: Valoria Villamarín JM. Cirugía Pediátrica. Madrid: Ediciones Díaz de Santos; 1994. p. 188-93.

5. Adetutu T, Temitola O, Chigbundu C, Olufemi I. Infantile hypertrophic pyloric stenosis with unusual presentations in Sagamu, Nigeria a case report and review of the literature. Pan Afr Med J. 2016; 24: 114.

6. Baeza CH, Villalobos CA, Arcos AA, López JC, García CL. Estenosis hipertrófica del píloro estudio clínico-epidemiológico. Acta Pediatr Mex. 2010; 31: 50-54.

7. Demeco C, Spagnuolo F, Mateos MF, Gentile LF. Malrotación intestinal como hallazgo en estudios del tracto digestivo en niños asintomáticos serie de casos. Rev Hosp Niños. 2014; 56 (252): 11-14.

8. Mesa D, Corrales JC, Ceciliano N. Malrotación intestinal Estudio comparativo entre hallazgos clínicos, radiológicos e intraoperatorio. Acta Pediátr. 1999; 13 (1): 27-32.

9. Bartlett ES, Carlisle EM, Makc GZ. Gastric outlet obstruction in a 12 year old male. Journal of Pediatric Surgery Case Reports. 2018; 31: 57-59.

10. Jiménez MG, Carmona R. Enfermedad de Jodhpur resuelta por piloroplastia laparoscópica Jodhpur Disease resolved by laparoscopic pyloroplasty. Acta Méd Costarric. 2015; 57 (1): 38-41