Focal Hypertrophy and Focal Spasm of the Pyloric Musculature in Adults

Abstract

In 1952 Bachmann reported 12 cases with localized areas of hypertrophy of the pyloric musculature in adults. In each instance the hypertrophied area was situated on the lesser curvature; it was found as incidental pathology in a series of 600 autopsies and none of the patients had any other abnormalities of the stomach and duodenum. The patients were divided into three groups according to the relationship to the pyloric “sphincter”. (Comment: the “sphincter” was equated with the pyloric ring.) In the first group (5 patients) the thickening was situated directly in the “sphincter”; it resembled an enlarged version of the normal sphincter, consisting mainly of circular but also containing some irregular and longitudinal muscle fibres. In the second group (4 patients) the thickening was located a very short distance orally to the “sphincter”, being separated from it by a narrow zone of normal tissues. In the third group (3 patients) it was situated in the “sphincter” as well as in the immediate prepyloric part. In the first two groups it appeared to be of a rounded or nodular character (while differing distinctly from a myoma), and in the third group it was rather longer than wide. In considering the pathogenesis, Bachmann asked himself whether these cases indicated that a certain part of the pyloric musculature was liable to undergo hypertrophy by virtue of its having a specialized function or structure.