Hourglass Stomach (Contracture) : Cause, Symptoms, & Treatment

Hourglass Stomach : Definition, Etiology, Signs, Symptoms, Diagnosis, & Management


  • It occurs exclusively in women, is due to cicatricial contracture of lesser curve ulcer.
  • Here stomach is divided into two compartments.

Clinical features

  • Loss of periodicity
  • Persistent pain
  • Vomiting
  • Loss of appetite and weight


  • Barium meal: It shows filling only in the proximal stomach or double pouched stomach.
  • Gastroscopy.


  • Partial gastrectomy wherein gastric ulcer with lower compartment of the stomach is removed and Billroth-I anastomosis is done.

Hourglass Stomach is usually seen as complication of gastric ulcer.

Gastric Ulcer


Daintree Johnson Classification

Type Location Incidence Acid level
Type I In the antrum, near the lesser curve 55% Normal
Type II Combined gastric ulcer (in the body) with duodenal ulcer 25% High
Type III Prepyloric ulcer 15% High
Type IV Gastric ulcer in the proximal stomach or cardia 5% Normal
Type V Diffuse ulcer (due to NSAIDs)


1. Hourglass stomach

2. Tea-pot stomach (Hand-Bag stomach)

  • It is due to cicatrisation and shortening of the lesser curvature.
  • They present with features of pyloric stenosis.
  • Treatment is partial gastrectomy with Billroth-I anastomosis.

 3. Perforation
4. Bleeding

  • Bleeding artery: Left gastric artery

5. Gastric outlet obstruction

6. Penetration

  • Posteriorly into pancreas, anteriorly into liver.

7. Malignancy


A. Medical

B. Surgical

  • Gastrectomy + Billroth anastomosis

Preferred are

  1. Partial gastrectomy + Billroth I : For gastric ulcer
  2. Gastrectomy + Billroth II : For distal gastric ulcer, duodenal ulcer
  3. Gastrectomy + Polya

Gastric Ulcer v/s Duodenal Ulcer

Features Gastric (Stomach) Ulcer Duodenal Ulcer
Etiology ↓ mucosal resistence ↑ acid production
H. pylori association 75% 90%
Pain Continuous, Increases on taking meal, More in lean & thin Seasonal, Increases with hunger, Decreases on taking meal, More in obese
Complications Perforations (most common), Bleeding (left gastric artery) Bleeding (most common)(bleeding artery: gastroduodenal artery)
Haematemesis : Malaena 60:40 40:60
Cancer Found Rare
Weight Weight loss Weight gain
Treatment Gastrectomy Vagotomy & Drainage

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