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Am J Dis Child. 1964;108(4):440. doi:10.1001/archpedi.1964.02090010442019.
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To the Editor: In the article "Hypertrophy of the Pyloric Mucosa" (Amer J Dis Child 107:636, 1964), the opening statement is:

"Congenital pyloric stenosis secondary to muscular hypertrophy has not been associated with mucosal or submucosal abnormalities in infants who are less than 1 week old."

This may well be true, but every surgeon experienced in infantile pyloric stenosis knows that at any age the mucosa always plays a significant role in the obstruction. This may not be by hypertrophy, but certainly is by swelling and edema, with or without redundancy.

The lumen is never completely blocked by muscular hypertrophy, but is so narrowed that the mucosa is bunched and overlapped, and jammed into the inadequate passage way. For students I have likened this to a wadded-up handkerchief in a funnel. Fluid poured on it will not flow past, but must ooze, or, as Dr. Brennemann used to say, "slither"


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