NONOBSTRUCTIVE MUCOSAL DIAPHRAGMS OR RINGS OF THE GASTRIC ANTRUM IN ADULTS

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Abstract
Antral diaphragm or ring is a persistent symmetric mucosal septum of 2-4 mm. thickness which protrudes vertically into the lumen a few centimeters proximal to the pylorus. The majority of 41 previously reported adult patients underwent surgery to relieve gastric outlet obstruction resulting from the small orifice of the antral diaphragm. Six cases of nonstenotic form are herein described and the pertinent literature is reviewed. In this series there were 4 female and 2 male patients. The average age at the time of diagnosis was 50 years. It is noted that obstructive symptoms are absent if the diameter of diaphragmatic aperture exceeds 1 cm. Nevertheless, patients often present with prolonged history of intermittent postprandial epigastric pain and sensation of fullness. These are mainly due to associated peptic ulcers and/or hiatal hernia as documented in all cases of this series. The coexistence of the lower esophageal ring and antral diaphragm in 3 patients is also described with emphasis on clinical and morphologic similarities between these lesions. Roentgenographic demonstration of antral diaphragm requires examination of the patient in recumbent oblique position, and maximal air-contrast distention of the stomach. Premedication with anticholinergic drugs is useful for both gastroscopic and roentgenologic visualization of the lesion.

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