Evolution in the Recognition of Infantile Hypertrophic Pyloric Stenosis

Abstract

ABSTRACT. Purpose. To analyze changes in the clinical condition at presentation and methods of establishing the diagnosis of infantile hypertrophic pyloric stenosis (IHPS).Methods. Retrospective review of patients who underwent pyloromyotomy (PM) for suspected IHPS at two institutions from 1969 through 1994 was performed. For the purposes of comparison, the population was divided into five equal time periods.Results. Over the 25-year period, 901 infants underwent PM. Patients presented at a younger age, weighed more, and had a shorter length of illness in the most recent time period. Hypochloremic alkalosis was found half as frequently in the most recent time period compared to the earliest group. A palpable pyloric tumor was present in 79% of patients in the earliest time period compared with 23% in the most recent time period. Sixty-one percent of patients in the earliest group and 96% in the latest group underwent an imaging study, reflecting the referring physician's evaluation before referral to the surgeon.Conclusions. Currently, patients with IHPS less frequently present with the clinical hallmarks of the disease. The use of imaging studies to establish the diagnosis has become common practice. The result has been the diagnosis of IHPS before alkalosis has developed, a shorter clinical course, less morbidity, and a shorter postoperative hospital stay. Pediatrics 1997;100(2). URL: http://www.pediatrics.org/ cgi/content/full/100/2/e9; pyloric stenosis, pyloromyotomy, diagnosis, hypochloremic alkalosis, upper gastrointestinal series, abdominal ultrasonography.ABBREVIATIONS. IHPS, infantile hypertrophic pyloric stenosis; UGI, upper gastrointestinal series; U/S, ultrasound; PM, pyloromyotomy; PLOS, preoperative length of stay; TLOS, total length of stay.T raditionally, the diagnosis of infantile hypertrophic pyloric stenosis (IHPS) is based on a history of projectile, nonbilious vomiting, and palpation of a pyloric tumor.1,2 The presence of hypochloremic alkalosis has also been associated with IHPS.3 Infants with historical but not physical findings consistent with IHPS undergo radiologic evaluation by either upper gastrointestinal series (UGI) or, more recently, abdominal ultrasound (U/S) to establish the diagnosis. The increased reliance of radiologic tests to diagnose IHPS has been ascribed to inexperienced examiners not palpating a pyloric tumor and subsequently proceeding with further evaluation. 4 -6 To evaluate temporal trends in the presentation and methods of diagnosis of IHPS, we performed a review of patients who underwent pyloromyotomy (PM) in the past 25 years. PATIENTS AND METHODSA retrospective chart review of patients who underwent PM for suspected IHPS at two teaching institutions between 1969 and 1994 was performed. All patients were examined and subsequently operated on by one of the authors (T.J.C., J.R.C., M.W.H.). Only patients with confirmed IHPS at the time of surgery were included in this analysis. Data included demographic information, history of illness, physical findings, admission...

Is There a Relation Between Pyloric Muscle Thickness and Clinical and Laboratory Data in Infants with Hypertrophic Pyloric Stenosis?

“…The affected infants may be dehydrated and/or lethargic. The presence of the classical hypochloremic metabolic alkalosis aids in the diagnosis, but it is not always present in PS [6][7][8]. Although palpation of the pyloric mass (olive) is diagnostic, it may be not detected in 11 % to 51 % of cases [9,10].…”

A Report of Ten Cases of Infantile Hypertropic Pyloric Stenosis Treated by Ramstedt’s Operation

“…It is a benign condition that cause severe projectile non-bilious vomiting in the first few months of life (2). Infantile hypertrophic pyloric stenosis occurs more often in boys then in a girls, and is rare in children older than 6 months (3).…”

Stenosis pylori – a

“…Po wyrówna-niu zaburzeń elektrolitowych u dziecka najczęściej wykonuje się pyloromiotomię metodą Ramstedta-Webera. U dorosłych zwykle stosuje się metodę Heinekego-Mikulicza [3][4][5][6][7]. Do rzadszych przyczyn zwężenia odźwiernika należą przedłużające się stany zapalne w obrębie opuszki dwunastnicy i samego odźwiernika, powikłania pooperacyjne po zabiegach wewnątrzotrzewnowych w obrębie dróg żółciowych, dwunastnicy i żołądka, uszkodzenia pourazowe w wyniku połknięcia ciała obcego oraz nowotwory żołądka, dwunastnicy i trzustki [8,9].…”