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1. Organoaxial rotation

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Figure 35-1

Organoaxial rotation.

The stomach is flipped such that the greater curvature is superior to the lesser curvature and the antrum empties inferiorly. There is no obstruction in this asymptomatic 4-month-old.

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2. Pyloric atresia

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Figure 35-2

Pyloric atresia.

A. There is no bowel gas beyond the slightly dilated stomach in this newborn with nonbilious vomiting. B. An image from a contrast fluoroscopic study shows complete obstruction at the level of the pylorus. The proximal aspect of the pyloric channel is dilated.

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3. Microgastria

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Figure 35-3

Microgastria.

A, B. Anteroposterior and oblique images from a barium upper GI examination show a small-capacity stomach (S) that has a tubular configuration. The duodenal bulb (D) is prominent. There is gastroesophageal reflux.

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4. Congenital intrathoracic stomach

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Figure 35-4

Congenital intrathoracic stomach.

An Anteroposterior radiograph of a newborn infant shows the gas-filled stomach to be in the inferior aspect of the mediastinum. The greater curvature is superior, indicating an organoaxial volvulus.

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5. Hypertrophic pyloric stenosis

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Figure 35-5

Hypertrophic pyloric stenosis.

An oblique radiograph of the upper portion of the abdomen of a 7-week-old infant shows prominent peristaltic contractions in a dilated stomach. This is the "caterpillar sign."

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6. Gastric pneumatosis

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Figure 35-6

Gastric pneumatosis.

An abdominal radiograph of a 29-day-old infant with a 3-day history of projectile vomiting shows linear gas collections in the stomach wall (arrows). The stomach is distended. There is a paucity of distal bowel gas.

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7. Hypertrophic pyloric stenosis

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Figure 35-7

Hypertrophic pyloric stenosis.

A steep oblique image shows elongation and narrowing of the pyloric channel, the string sign. There is a curved configuration of the pylorus, the J sign. There is a "beak" of contrast at the entrance of the pylorus. Impression on the antrum by the pyloric muscle produces the shoulder sign (arrow).

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8. Hypertrophic pyloric stenosis; the double string sign

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Figure 35-8

Hypertrophic pyloric stenosis; the double string sign.

An oblique barium fluoroscopic image shows 2 thin channels of contrast (arrow) within the elongated pylorus.

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9. Hypertrophic pyloric stenosis

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