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K31.1 – Adult Hypertrophic Pyloric Stenosis
K31.1 is an ICD-10 diagnosis code for adult hypertrophic pyloric stenosis, a narrowing of the gastric outlet that obstructs the passage of food into the small intestine.
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K31.1 is an ICD-10 diagnosis code for adult hypertrophic pyloric stenosis, a narrowing of the gastric outlet that obstructs the passage of food into the small intestine.
What does the ICD-10 Code K31.1 mean?
The ICD-10 code K31.1 refers to adult hypertrophic pyloric stenosis. This is a narrowing (stenosis) of the pylorus – the junction between the stomach and the duodenum (small intestine) – caused by a thickening (hypertrophy) of the muscular layer. This condition impairs or prevents the emptying of stomach contents into the intestine.
Causes
Hypertrophic pyloric stenosis in adults is considerably rarer than in infants. Possible causes include:
- Primary (idiopathic) form: Thickening of the pyloric muscle without an identifiable underlying disease, possibly as a late manifestation of infantile pyloric stenosis
- Secondary form: Develops as a consequence of other conditions such as chronic peptic ulcers, gastric cancer, Crohn's disease, or chronic gastritis in the pyloric region
- Scar-related strictures: Resulting from repeated inflammation or extension of ulcers to the pylorus
Symptoms
The symptoms associated with K31.1 often develop gradually. Typical symptoms include:
- Postprandial vomiting: Projectile vomiting of undigested food shortly after eating
- Epigastric pain: Pressure sensation or pain in the upper abdomen
- Early satiety and bloating
- Weight loss due to impaired food intake
- Electrolyte disturbances (e.g., hypochloremic alkalosis) in chronic cases
- Visible gastric peristalsis in the upper abdomen (in lean patients)
Diagnosis
Several diagnostic methods are available to confirm this diagnosis:
- Esophagogastroduodenoscopy (gastroscopy): Gold standard for direct assessment of the pylorus, exclusion of malignancy, and biopsy
- Abdominal ultrasound: Can detect thickening of the pyloric musculature
- Barium meal X-ray (upper GI series): Demonstrates delayed gastric emptying and pyloric narrowing
- CT abdomen: Used to rule out tumors or other organic causes
- Laboratory tests: Detection of electrolyte disturbances (hyponatremia, hypokalemia, metabolic alkalosis)
Treatment
Conservative Management
In mild cases or when a secondary cause can be addressed:
- Treatment of the underlying condition (e.g., acid suppression therapy with proton pump inhibitors for peptic ulcer)
- Dietary adjustments (small, frequent meals, liquid diet)
- Correction of electrolyte imbalances via intravenous infusion
Endoscopic Treatment
- Pneumatic balloon dilation: Widening of the pylorus using a balloon via endoscope – the preferred minimally invasive approach
- Endoscopic incision: Cutting the pyloric muscle in refractory cases
Surgical Treatment
- Pyloromyotomy (Ramstedt procedure): Longitudinal splitting of the thickened pyloric muscle without opening the mucosa
- Pyloroplasty or gastric resection: Indicated for secondary causes (e.g., tumor) or complicated cases
References
- World Health Organization (WHO) – ICD-10 Version 2019: K31.1 Adult hypertrophic pyloric stenosis. https://icd.who.int/browse10/
- Iqbal, C. W. et al. – Adult hypertrophic pyloric stenosis. Journal of Gastrointestinal Surgery, 2006. https://pubmed.ncbi.nlm.nih.gov/
- Feldman, M., Friedman, L. S., Brandt, L. J. – Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th edition, Elsevier, 2021.
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