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Differential diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Carcinoma of the pylorus is by far the most important differential diagnosis of adult pyloric stenosis.

Rare causes of pyloric obstruction include:

  • adult pyloric hypertrophy
  • scarring secondary to a benign gastric ulcer near the pylorus
  • a chronic stricture resulting from a duodenal ulcer
  • invasion of the pylorus by malignant lymph nodes e.g. non-Hodgkins lymphoma
  • infiltration from a pancreatic carcinoma

Clues to the aetiology are provided by the history and examination.

  • length of history: a history of several years of characteristic peptic ulcer pain in contrast to cancer with a painless history lasting months
  • gross dilatation of the stomach favours a benign lesion
  • the presence of a mass at the pylorus indicates probable malignant disease. However in rare instances a palpable inflammatory mass in association with a large duodenal ulcer can be detected.

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