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  1. Congenital Hypertrophic Pyloric Stenosis (CHPS)
    It is the most common acquired obstruction of the young infant.
    It is more common in males and develops usually between the third and sixth weeks of life.
    The clinical triad of projectile vomiting, visible gastric peristaltic waves, and a palpable pyloric mass are frequently diagnostic.
    Increase incidence in firstborn male child with M:F ratio 4:1.
    Inherited as dominant polygenic trait.
    1. Manifestations:
      1. Usual age of presentation is 3–6 weeks of life with non-bilious projectile vomiting
      2. Palpable olive-shaped epigastric mass
      3. Nasogastric aspirate >10mL
      4. Positive family history
      5. Hypochloremic, hypokalemic metabolic alkalosis
    2. Barium study features of CHPS
      1. Elongation and narrowing of pyloric canal (2–4 cm length)
      2. Passing of small barium streak through pyloric canal seen as a string of barium known as string sign.
      3. Crowding of muscle folds in pyloric canal known as double/triple track sign.
      4. Transient triangular tent-like cleft/niche in mid portion of pyloric canal with apex pointing inferiorly; seen due to mucosal belonging between 2 separated hypertrophied muscle bundles on greater curvature side within pyloric canal, known as diamond sign/twining recess.
      5. Outpouching along lesser curvature due to disruption of antral peristalsis, known as pyloric teat/teat sign.
      6. Mass impression upon antrum with streak of barium pointing toward pyloric channel, known as beak sign/antral beaking.
      7. Indentation of the base of duodenal bulb known as umbrella/kirkling/ mushroom sign.
      8. Gastric hyperperistaltic waves known as caterpillar sign.
      9. Gastric distension with fluid.
        Ultrasound (investigation of choice)Q
        Criteria for diagnosis include ​
  1. An elongated pyloric channel (longer than 16 mm),
  2. An enlarged pyloric diameter (greater than 14 mm),
  3. A thickened muscle wall (greater than 4 mm).
Target Sign: Hypoechoic ring and hypertrophied pyloric muscle around echogenic mucosa centrally (transverse scan).
Features Benign ulcer Malignant ulcer
Incidence 95% 5%
Location Distal stomach and the lesser curvature distally) (Posterior wall> Anterior wall)
Fundus and prox half of greater curvature
Ba studies (Enface)
(End on)
1. Round or oval, sometimes tear-drop like or with linear contour (collection of Ba on dependent wall)
2. Ring Shadow with barium coating edge of the ulcer crater (ulcer on nondependent wall or is not filled with barium)
3. To the edge of ulcer crater (good sign of benignancy)
Distorted folds & folds do not reach up to ulcer edge due to surrounding desmoplasia

In profile 1. 'Ulcer niche' (Project beyond lumen of stomach)
2. 'Hampton's line': a pencil-thin line of lucency seen crossing the base of the ulcer (due to preserved gastric mucosa with undermining of more vulnerable submucosa) virtual diaprossis.
3. Ulcer collar (thicker smooth)

Kirklin complex
Carman’s Meniscus sign


  1. Simultaneous involvement of pylorus + duodenum 'linitus plastic' appearance.
  2. Linitus plastic may also be a feature of gastric lymphoma and scirrhous carcinoma, eosinophilic gastritis

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