Since the occurrence of idiopathic hypertrophic pyloric stenosis in the adult is rare, no surgeon has had vast experience in the management of patients with this condition. The gross pathologic anatomy of this lesion is apparently identical with that of the common, more easily diagnosed infantile form of hypertrophic pyloric stenosis, and it is possible that these 2 clinical entities are related. Cruvielhier (cited by Mack 20 ) (1835) was the first to describe the pathologic anatomy of hypertrophic pyloric stenosis in an adult. His case occurred in a 72-year-old woman with a long history of vomiting. Maier 21 in 1885 first described it as a clinical entity based on pathologic findings at necropsy. The first surgical cure in an adult was reported by Mayo-Robson 22 in 1904, who utilized a gastroenterostomy. Two patients with this condition were recently encountered at the Veterans Administration Hospital, Oteen, N.C. These 2 cases directed

Idiopathic hypertrophic pyloric stenosis in the adult. A review of the literature and the report of two cases.

Increasing numbers of patients in the older age group of 60 to 75 years, and many in the extreme age group of 75 years and over, are tolerating surgical procedures of some magnitude, with decreasing postoperative morbidity and mortality. Evidence is growing that elderly patients can withstand moderate major operations with a mortality rate not far removed from that for operations on younger patients. Nevertheless, for radical major operative procedures, the mortality in the elderly remains much higher. There is an ever-present challenge when operating upon elderly patients, because the majority have an already decreased physiologic reserve, with often one or more concurrent complicating diseases and deficiencies. Of greatest significance over the past two or three decades has been a realization of the importance of preoperative correction of complications as early as possible in the aged patient, even though the correction be only temporary. Keener insight into the physiologic alterations of the aging process has improved operability, avoided much postoperative morbidity, and immeasurably reduced the problems and hazards of geriatric surgery. Opinions differ as to when a person has reached old age, and at what age senile changes begin to have a marked effect on organs and tissues of the body. This continues to be a moot question, of special interest to those concerned with surgical operations on the aged. Any attempt at a definitive answer, must be hypothetical. We have seen patients who are seemingly old at 60 or less, and those who often show little significant evidence of physiologic senescence at 75 or more. Chronologie age alone, no longer determines physiologic aging. Oberhelman (1) points out that\" ... one often sees persons who are chronologically young but biologically old, and conversely, persons who are chronologically old but biologically young.\" In the final analysis, the clinical findings are our best index to the degree of physiologic reserve of the aged patient, although we cannot postulate the exact age at which changes begin to take place. In the reports of those concerned with

H W Southwick

Papers

Idiopathic hypertrophic pyloric stenosis in an elderly adult.