Congenital hypertrophic pyloric stenosis

Infantile Hypertrophic Pyloric Stenosis Recurring after Rammstedt's Operation

“…It is possible that a modification of the classical Rammstedt's operation might be more successful in cases of relapse. Grimes et al (1950) reported less post-operation regurgitation in cases where an elliptical wedge of tissue was removed for histological section and this procedure might be worthy of trial in selected cases. The disadvantage of this operation is the increased risk of haemorrhage and formation of adhesions.…”

“…The persistence of some vomiting during the first few days after operation is common and is usually attributed to long-standing gastric distension with gastritis. This can be minimized by reducing the feeds and in severe cases by stopping all oral feeding and substituting parenteral fluids (Wood and Smellie, 1951;Grimes, Bell and Olney, 1950;Szilagyi and McGraw, 1943;Jewesbury and Page, 1937;Parsons and Barling, 1923). Faber and Davis (1940) have shown that gastric peristalsis is completely inhibited for several hours after operation and depressed for 24 hours or more.…”

“…They considered re-operation in a second case but the child responded to medical treatment. Grimes et al (1950) cite one case of recurrence, the second operation being performed through a different area. Frazier and Warfield (1949) consider that inadequate division was the cause of continued vomiting in their case, which was re-operated on six weeks after the FIG.…”