A 4-week-old male infant is brought to the emergency department by his mother for a concern about forceful vomiting after each feed for the past 2 days. The prenatal course and delivery were unremarkable. His heart rate is 180 beats per minute and a temperature of 99°F (36.2°C). Physical examination shows depressed fontanelles, dry mucous membranes, poor skin turgor, and lethargy. Blood tests show the following:
Ultrasound of the abdomen confirms the diagnosis of pyloric stenosis. Intravenous fluids are started and surgery is planned. Which of the following is the blood supply of this region of the stomach?
A) Gastroduodenal artery
The patient has infantile hypertrophic pyloric stenosis. Presentation varies depending on the severity of the outlet obstruction and degree of dehydration. This area of the stomach is supplied by the gastroduodenal artery.
Answer choice B: Left gastric artery, is incorrect. The left gastric artery supplies the lesser curvature of the stomach. It arises directly from the coeliac trunk.
Answer choice C: Right gastric artery, is incorrect. The right gastric artery is one of the branches of the proper hepatic artery, which arises from the common hepatic artery. This artery supplies the greater curvature of the stomach.
Answer choice D: Superior mesenteric artery, is incorrect. The superior mesenteric artery supplies the midgut structures.
Answer choice E: Superior pancreaticoduodenal artery, is incorrect. The superior pancreaticoduodenal artery is a branch of the common hepatic artery. It supplies blood to the duodenum and pancreas.
Key Learning Point
Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is an uncommon condition in infants characterized by abnormal thickening of the pylorus muscles in the stomach leading to gastric outlet obstruction. Clinically the infant is well at birth. Then, at 3 to 6 weeks of age, the infant presents with "projectile" vomiting, potentially leading to dehydration and weight loss. The pyloric part of the stomach receives arterial blood from the gastroduodenal artery, which stems from the common hepatic artery.
