Ultrasound Value in the Early Diagnosis and Exclusion of Idiopathic Hypertrophic Pyloric Stenosis: 10 Years Experience at Babylon Governorate

Abstract

Background: Idiopathic Hypertrophic Pyloric Stenosis (IHPS) is one of the most common surgical conditions of early infancy, presenting in 1.5 to 4 per 1000 live births. Despite this high prevalence, the precise etiology remains poorly understood. The diagnosis is made primarily with history and physical examination. Projectile, non-bilious vomiting is the classic presentation of an infant with IHPS. The typical physical exam findings include visible peristaltic waves and palpation of the olive mass in the upper abdomen. In the absence of a palpable mass, an upper gastrointestinal (UGI) barium study or ultrasonographic evaluation will usually make the diagnosis. Ultrasound is the preferred modality to diagnose IHPS. Demonstration of pyloric muscle thickness of 3.5 mm to 4 mm or more and pyloric channel length of 16 mm or more increases the specificity of the ultrasound to 100%.

Sonography and Test-Feeding in the Diagnosis of Infantile Hypertrophic Pyloric Stenosis

“…19 Among all positive cases, 75.36% were male and 34.64% were female with a male to female ratio of almost 3:1. 19 It was concluded that sonography was a noninvasive and harmless imaging modality for the diagnosis of IHPS. 19 In a study by Hernanz-Schulman, 22 the etiological hypotheses and epidemiology of the condition was examined and the evidence supporting the various diagnostic investigations conducted.…”

“…17,18 Sometimes it can progress to almost near-complete occlusion of the gastric outlet, leading to projectile vomiting. 19,20 IHPS occurs in approximately 0.2 to 0.35 of live births, although rates and trends vary markedly from region to region. 21 It is more common in males than in females.…”

“…19 It was concluded that sonography was a noninvasive and harmless imaging modality for the diagnosis of IHPS. 19 In a study by Hernanz-Schulman, 22 the etiological hypotheses and epidemiology of the condition was examined and the evidence supporting the various diagnostic investigations conducted. They observed that IHPS is predominant in males and the male to female ratio was estimated in the range of 2.5:1 to 5.5:1.…”

“…The accuracy of sonography was evaluated in the diagnosis and exclusion of IHPS, in infants with positive feed-test and no obvious palpable pyloric mass, in a study by Resheed. 19 In that study, 146 infants suspected of IHPS were scanned and their sonographic results (47.25%) were declared positive, while the remainder were deemed negative (52.73%). 19 Among all positive cases, 75.36% were male and 34.64% were female with a male to female ratio of almost 3:1.…”

“…19 In that study, 146 infants suspected of IHPS were scanned and their sonographic results (47.25%) were declared positive, while the remainder were deemed negative (52.73%). 19 Among all positive cases, 75.36% were male and 34.64% were female with a male to female ratio of almost 3:1. 19 It was concluded that sonography was a noninvasive and harmless imaging modality for the diagnosis of IHPS.…”