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K31.2 Pyloric Stenosis – Causes, Symptoms & Treatment
K31.2 is an ICD-10 diagnosis code for pyloric stenosis in adults – a narrowing of the gastric outlet that obstructs the passage of stomach contents.
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K31.2 is an ICD-10 diagnosis code for pyloric stenosis in adults – a narrowing of the gastric outlet that obstructs the passage of stomach contents.
What is K31.2?
The ICD-10 code K31.2 refers to pyloric stenosis in adults, also known as acquired gastric outlet obstruction. The pylorus is the muscular valve connecting the stomach to the duodenum (the first part of the small intestine). When this passage becomes narrowed (stenosis), stomach contents cannot pass adequately into the small intestine. Unlike the congenital hypertrophic pyloric stenosis seen in infants, K31.2 describes an acquired form that develops during adulthood.
Causes
Acquired pyloric stenosis in adults usually develops as a complication of other conditions affecting the stomach or surrounding structures. Common causes include:
- Peptic ulcer disease: Recurrent gastric or duodenal ulcers near the pylorus lead to scar tissue formation and progressive narrowing.
- Gastric cancer: Tumors located at or near the gastric outlet can obstruct the pylorus from the inside or by external compression.
- Chronic gastritis: Long-standing inflammation can cause thickening and scarring of the stomach wall.
- Crohn's disease: This chronic inflammatory bowel disease can occasionally involve the gastric outlet.
- Pancreatitis or pancreatic carcinoma: Diseases of the pancreas, which lies in close anatomical proximity to the pylorus, may compress it externally.
Symptoms
Symptoms of pyloric stenosis in adults typically develop gradually and may initially go unrecognized. Common complaints include:
- Nausea and vomiting, often containing undigested or partially digested food
- Postprandial fullness, bloating, and discomfort after eating
- Epigastric pain or pressure in the upper abdomen
- Weight loss and loss of appetite due to insufficient nutrient absorption
- Dehydration and electrolyte imbalances (e.g., low potassium levels) as a result of repeated vomiting
- Visible gastric distension in advanced cases
Diagnosis
Several diagnostic procedures are available to confirm pyloric stenosis:
- Esophagogastroduodenoscopy (EGD / gastroscopy): This is the primary diagnostic tool. It allows direct visualization of the narrowing and enables tissue biopsy to rule out malignancy.
- Barium swallow / upper GI series: Demonstrates delayed gastric emptying and the extent of the obstruction using contrast medium under X-ray.
- Abdominal computed tomography (CT scan): Used to assess surrounding structures and exclude tumors or pancreatic disease.
- Gastric emptying scintigraphy: A nuclear medicine technique to quantitatively measure the rate of gastric emptying.
- Blood tests and electrolyte panels: To detect metabolic abnormalities, particularly hypochloremic metabolic alkalosis caused by vomiting.
Treatment
Treatment depends on the underlying cause of the stenosis:
Conservative Management
In mild cases or as a bridging measure, a nasogastric tube may be inserted to decompress the stomach. Intravenous fluid and electrolyte replacement is initiated to correct dehydration and metabolic disturbances.
Endoscopic Treatment
For scarring-related stenosis (e.g., post-ulcer), endoscopic balloon dilation is a well-established option. A balloon catheter is passed through the endoscope to the site of the narrowing and inflated to widen the pylorus. This procedure can be repeated if necessary.
Surgical Treatment
In severe, refractory cases or when a tumor is the underlying cause, surgical intervention is required:
- Pyloroplasty: Surgical widening of the pyloric channel
- Gastroenterostomy: Creation of a bypass connection between the stomach and the small intestine
- Partial gastrectomy: Partial removal of the stomach, particularly in malignant cases
Treatment of the Underlying Cause
Addressing the root cause is essential to overall management – for example, acid suppression therapy and Helicobacter pylori eradication for ulcer disease, or oncological treatment for gastric cancer.
References
- Longo, D. L. et al.: Harrison's Principles of Internal Medicine, 21st edition. McGraw-Hill, New York 2022.
- Feldman, M. et al.: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th edition. Elsevier, Philadelphia 2021.
- World Health Organization (WHO): ICD-10 Version 2019 – K31.2 Hourglass stricture and stenosis of stomach. Online: www.who.int/classifications/icd
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