The Myenteric Plexus in Infantile Hypertrophic Pyloric Stenosis

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Abstract
Current opinion suggests that the primary factor in the etiology of infantile hypertrophic stenosis is a defect in the pyloric myenteric plexus. One view holds that the ganglion cells are immature; another that the cells are degenerated. Thirty-eight biopsy specimens of pyloric musculature from infants treated surgically for the condition were examined histologically and compared with similar sections from control material. There were present in normal pylorus two morphologically distinct ganglion cell types corresponding to (Dogiel) Types I and II neurons, but that (Dogiel) Type I neurons were virtually absent from the pylorus in congenital pyloric stenosis. Whether the absence of Type I cells is due to degeneration of these cells subsequent to excessive parasympathetic stimulation or to some failure in their development is uncertain. No evidence of advanced neuronal degeneration in biopsy specimens of pylorus from infants suffering from congenital pyloric stenosis was found. Signs of nerve degeneration described by previous workers may be artefacts caused by imperfect methods of preparation of tissue for histological examination.