Late-Onset Hypertrophic Pyloric Stenosis in a 14-Weeks-Old Full Term Male Infant

Abstract

Background: Hypertrophic pyloric stenosis is the most common cause of gastric outlet obstruction in infants, and classically presents at 2 to 6 weeks of age. Delayed presentation is an extremely rare occurrence after early infancy. Case report: A 14-weeks-old full term male infant presented with non-bilious vomiting, dehydration and hypocloremic metabolic alkalosis. Abdominal ultrasonography revealed tubular mass 20 mm in lenght. Because of unusual age, diagnosis was confirmed with upper gastrointestinal contrast study. Laparoscopic pyloromyotomy was performed. After surgery the child was free of symptoms, had gained weight, and was tolerating a regular diet. Message: Despite the age hypertrophic pyloric stenosis should be kept in mind in any child who presents with non-bilious vomiting.

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

“…This condition, in most of the cases, occurs between the third and sixth week of life [1,4]. In very rare cases late onset presentation of hypertrophic pyloric stenosis has been described, with age ranging from three months to five years of age [5]. In the beginning, infants occasionally vomit after the meal.…”

“…In the majority of the centers traditional laparoscopic pyloromyotomy is performed using a retractable pyloromyotomy knife for incision of the hypertrophied pylorus [5,6,[15][16][17][18]. However, in all centers, especially in countries with lower socio-economic status, such an instrument is not always available, so pediatric surgeons used various modifications of this knife to perform the procedure by laparoscopic approach.…”

Estenosis hipertrófica congénita del píloro

“…Igualmente, deben diferenciarse de la EHP las infecciones del sistema nervioso central como la meningoencefalitis viral y bacterianas, que también causan vómitos en proyectil, así como las infecciones del tracto urinario, entre otras. (25) Por último, existen otras afecciones congénitas quirúrgicas en pediatría que deben descartarse, tales como el páncreas anular en el recién nacido -que impide el libre paso del contenido gástrico y causa un cuadro de retención gástrica, vómitos y oclusión alta-las atresias intestinales, el vólvulo intestinal, la hernia interna, las bandas de Ladd, la hernia inguinal atascada, entre otras afecciones pediátricas que causan cuadro de oclusión intestinal y vómitos. (26) AFECCIONES CLÍNICO-QUIRÚRGICAS FRECUENTES EN LA INFANCIA CAP.…”

Transumbilical single-site two incision laparoscopic pyloromyotomy for pediatric hypertrophic pyloric stenosis

“…Patients presenting in the first 2 weeks of life had a significantly higher positive family history for HPS than infants who presented with HPS after day 14 of life [ 3 ]. In addition to the early presentation of HPS, late presentation of HPS at the 14th week of life has been reported in the literature as a rare event [ 4 ].…”