Anatomy of the Pyloric Ring

Abstract Background and study aims Eosinophilic gastrointestinal disorders are classified into eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, and eosinophilic colitis according to the site of eosinophilic infiltration. Although well established in eosinophilic esophagitis, endoscopic findings in eosinophilic gastritis and eosinophilic gastroenteritis with regard to gastric lesions have not been clearly described. The aim of this study was to identify endoscopic findings of gastric lesions associated with eosinophilic gastrointestinal disorders. Patients and methods Out of 278 patients with eosinophilic gastrointestinal disorders, 18 had eosinophilic gastritis or eosinophilic gastroenteritis confirmed by biopsy; their endoscopic images were analyzed retrospectively. The association between endoscopic findings and number of eosinophils in the gastric mucosa was investigated. Results Erythema was most frequently observed (72 %), followed by ulcers (39 %), discoloration (33 %), erosions (28 %), nodularity (28 %), and polyps (28 %). There were several unique endoscopic findings such as submucosal tumor-like deep large ulcers in three patients, antral Penthorum-like appearances (small nodules radially lined toward the pyloric ring) in three patients, “muskmelon-like appearances” (discolored mucosa-composed mesh pattern) in three patients, multiple white granular elevations in two patients, cracks (appearance of furrows similar to those in eosinophilic esophagitis) in five patients, and antral rings in one patient. No significant association was observed between endoscopic findings and number of gastric eosinophils. Conclusions Several unique endoscopic findings of gastric lesions were observed in patients with eosinophilic gastritis or eosinophilic gastroenteritis. Submucosal tumor-like ulcers, antral Penthorum-like appearances, muskmelon-like appearances, and cracks might be associated with eosinophilic gastrointestinal disorders.

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Does pyloric-ring resection in pancreaticoduodenectomy prevent delayed gastric emptying?

HPB ◽

10.1016/j.hpb.2018.06.2264 ◽

2018 ◽

Vol 20 ◽

pp. S649

Author(s):

T. Pitakteerabundit ◽

T. Thongkun ◽

N.-A. Wiboonkhawn

Keyword(s):

Gastric Emptying ◽

Delayed Gastric Emptying ◽

Pyloric Ring

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Gastric Emptying after Vagotomy and Pyloric Ring Stretch

Digestion ◽

10.1159/000198346 ◽

1979 ◽

Vol 19 (3) ◽

pp. 210-212

Author(s):

N. Longrigg ◽

R. Pringle ◽

M. Wisbey

Keyword(s):

Gastric Emptying ◽

Pyloric Ring

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Incomplete Annular Pancreas with Ectopic Opening of the Pancreatic and Bile Ducts into the Pyloric Ring: First Report of a Rare Anomaly

Case Reports in Gastroenterology ◽

10.1159/000447292 ◽

2016 ◽

Vol 10 (2) ◽

pp. 373-380 ◽

Cited By ~ 2

Author(s):

Shinjiro Kobayashi ◽

Horoyuki Hoshino ◽

Kouhei Segami ◽

Satoshi Koizumi ◽

Nobuyuki Ooike ◽

...

Keyword(s):

Bile Duct ◽

Bile Ducts ◽

Extrahepatic Bile Duct ◽

Annular Pancreas ◽

Papilla Of Vater ◽

Duodenal Stenosis ◽

Pyloric Ring ◽

Ventral Pancreas ◽

Bile Excretion ◽

Small Holes

The patient was a 56-year-old woman who had experienced epigastralgia and dorsal pain several times over the last 20 years. She was admitted for a diagnosis of acute cholecystitis, and severe intra- and extrahepatic bile duct dilatation with inner air density was noted. No papilla of Vater was present in the descending duodenum, and 2 small holes were present in the pyloric ring. Bile excretion from one of the small holes was observed under forward-viewing endoscope. It was considered that the pancreatic and bile ducts separately opened into the pyloric ring. Based on these findings, malformation of the pancreaticobiliary duct was diagnosed. She did not wish treatment, but the obstruction associated with duodenal stenosis was noted after 2 years. Pancreatoduodenectomy was performed as curative treatment for duodenal stenosis and retrograde biliary infection through the bile duct opening in the pyloric ring. The ventral pancreas encompassed almost the entire circumference of the pyloric ring, suggesting a subtype of annular pancreas. Generally, lesions are present in the descending part of the duodenum in an annular pancreas, and the pancreatic and bile ducts join in the papillary region. However, in this patient, (1) the pancreas encompassed the pyloric ring, (2) the pancreatic and bile ducts opened separately, and (3) the openings of the pancreatic and bile ducts were present in the pyloric ring. The pancreas and biliary tract develop through a complex process, which may cause various types of malformation of the pancreaticobiliary system, but no similar case report was found on a literature search. This case was very rare and could not be classified in any type of congenital anomaly of the pancreas. We would classify it as a subtype of annular pancreas with separate ectopic opening of the pancreatic and bile ducts into the pyloric ring.

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Giant Polypoid Tumor Expressing on the Pyloric Ring

Case Reports in Medicine ◽

10.1155/2015/986971 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3

Author(s):

Hirofumi Sonoda ◽

Takashi Kobayashi ◽

Yuhei Endo ◽

Shoichi Irie ◽

Toru Hirata ◽

...

Keyword(s):

Papillary Adenocarcinoma ◽

Invasion Depth ◽

Pyloric Ring ◽

Positron Emission ◽

Histopathologic Diagnosis ◽

Old Japanese ◽

Mucosal Layer ◽

Precise Diagnosis ◽

Gastric Endoscopy ◽

Tomography Scan

A 66-year-old Japanese man was referred to our hospital because of suspected duodenal cancer. Upper gastric endoscopy revealed a giant polypoid-type tumor that extended from the duodenum bulb to the pyloric ring. A computed tomography scan revealed a slightly enhanced lobular tumor protruding into the duodenum bulb. Positron emission tomography showed an accumulation of18F-fluorodeoxyglucose in the area extending from the antrum of the stomach to the duodenum bulb. Since an endoscopic ultrasound test suggested that the tumor might invade the muscular tunic, indications of endoscopic mucosal resection were not favored, and the tumor was curatively removed via distal gastrectomy. The histopathologic diagnosis was papillary adenocarcinoma, and the invasion depth was the mucosal layer without vascular invasion, which was different from the preoperative diagnosis. Our case suggests the difficulties in precise diagnosis of the invasion depth of the giant polypoid cancer.

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