HIATUS HERNIA, PYLORIC MUSCLE HYPERTROPHY AND CONTRACTED PYLORIC SEGMENT IN ADULTS

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Abstract
The incidence of a contracted prepyloric segment in cases of hiatus hernia in adults was determined at barium meal examinations, and found to be 16.5 per cent. A similar appearance could be brought about experimentally in dogs by stimulating the intrahiatal parts of either the right or left vagus. In all the experimental animals this contraction occurred, being clearly confined to the specialized fibers of the muscularis propria known as the sphincteric cylinder of the pylorus, or the fanshaped muscle or canalis egestorius. This indicates a vagus reflex, described here for the first time, and called the hiatal-pyloric reflex. The contracted segment is due to hypertrophic pyloric stenosis in some cases. In most cases it is less severe but simulates this condition anatomically and roentgenologically, and is called pseudohypertrophic pyloric stenosis. Roentgenologists should comment on the state of the pyloric area in cases of hiatus hernia, as it may have a bearing on the surgical treatment.

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