Infantile hypertrophic pyloric stenosis: Has anything changed?

Abstract

Aim:The study aims to review the contemporary presentation, diagnosis and treatment of children with infantile hypertrophic pyloric stenosis (IHPS) at an Australian paediatric tertiary centre. Methods: A retrospective case review of patients with IHPS presenting to our institution between January 2004 and December 2010 was performed. Results were compared with a previous study evaluating two earlier 6-year series of patients treated between January 1984 and November 1995. Results: Of 362 infants presenting over the current 7-year review, 84.8% were male. Mean age of admission fell from 5.9 weeks in the previous study to 5.4 weeks. An 'olive' was palpated on examination in 48%, visible peristalsis seen in 25% and 16% of patients presented with haematemesis. Diagnosis solely on clinical examination fell from 74% to 9% and was associated with a corresponding increase in use of ultrasound from 16% to 91%. The frequency of serum chloride values less than 85 mmol/L declined from 26% to 9%. A variety of open and minimally invasive surgical approaches were used with similar outcomes, although laparoscopic pyloromyotomy was associated with significantly higher rates of wound infection (c 2 = 4.6, P = 0.03). The frequency of major complications remained low at 1%. Conclusion: Contemporary patients with IHPS typically present earlier with a reduction in the incidence of metabolic derangement. Diagnosis based on clinical examination alone appears uncommon, with the majority of suspected cases confirmed by ultrasound. There was no clear difference in overall outcome based on the surgical approach used, although minor variations may reflect our institution's initial experience with laparoscopic pyloromyotomy.

Esophageal atresia and hypertrofic pyloric stenosis: An association to consider

“…In 1986, Magilner reported 2 cases of this association and reviewed 35 reported cases. Since these reports, less than 20 cases have been reported in literature, we can realize that the delayed diagnostic is common [3,5] . Now, we report our experience.…”

“…Moreover, infantile HPS is a common paediatric condition with an incidence of 1 in 400 live births [3,5] . This pathology is 30 times more frequent in patients with EA [1] .…”

The use of ultrasonography in infantile hypertrophic pyloric stenosis: do the patient’s age and weight affect pyloric size and pyloric ratio?

“…Due to its high sensitivity and specificity without any risk of ionizing radiation and its ability to demonstrate other intraabdominal pathologies that might co-exist, US has been widely used as an imaging tool for IHPS diagnosis prior to surgery [6,12,13,[23][24][25]. US was also used in the follow-up of the healing process of medically treated IHPS [26] and in monitoring conservatively treated IHPS cases [16].…”

“…IHPS should be considered in any vomiting infant [4], though gastroesophageal reflux (GER), pylorospasm, hiatal hernia, and preampullary duodenal stenosis can also manifest with nonbilious vomiting [1]. The use of ultrasonography (US) in the diagnosis of IHPS evidenced an increase over time, compared to earlier periods [4][5][6]. Only in a few studies was the pyloric ratio (PR) evaluated and it was found to be an additional and useful US parameter in the diagnosis of IHPS in infants with different age and weights [7], including premature infants [8].…”

2012 Ultrasound First Forum Proceedings

“…Many times ultrasound is the only modality necessary, but when additional imaging is needed, ultrasound may be used to plan how to proceed further with a more expensive study that requires sedation. [32][33][34][35][36][37][38][39][40] Clinical Suspicion of Renal Colic: Ultrasound First?…”