Infantile Hypertrophic Pyloric Stenosis

Abstract

Infantile hypertrophic pyloric stenosis is a common condition affecting young infants; despite its frequency, it has been recognized only for a little over a century, and its etiology remains unknown. Nevertheless, understanding of the condition and of effective treatment have undergone a remarkable evolution in the 20th century, reducing the mortality rate from over 50% to nearly 0%. The lesion is characterized by gastric outlet obstruction and multiple anatomic abnormalities of the pyloric antrum. The antropyloric muscle is abnormally thickened and innervated, and the intervening lumen is obstructed by crowded and redundant mucosa. Recognition of the obstructive role of the mucosa led to discovery of effective surgical treatment. Accurate clinical diagnosis in patients in whom a thickened antropyloric muscle is not readily palpable can be difficult, resulting in delayed diagnosis and can lead to emaciation and electrolyte imbalance, making the patient a suboptimal surgical candidate. Current imaging techniques, particularly sonography, are noninvasive and accurate for identification of infantile hypertrophic pyloric stenosis. Successful imaging requires understanding of anatomic changes that occur in patients with this condition and plays an integral role in patient care. Accurate, rapid, noninvasive imaging techniques facilitate rapid referral of vomiting infants and prompt surgical treatment of more suitable surgical candidates.

Adult idiopathic hypertrophic pyloric stenosis - a common presentation with an uncommon diagnosis

“…This sign has been extensively studied in juvenile HPS and has been found to occur in 50% of pediatric patients [17], but its frequency is unclear in AIHPS. The sign can also be elicited by manual pressure on the stomach [18–20]. Abdominal CT scan shows nonspecific distal gastric wall thickening in some cases, as seen in our patient.…”

Pediatrik Abdomende Kontrastli Radyografi

“…Fizik muayenede zeytin (olive) adı verilen hipertrofik pilor kasının palpasyonla hissedilmesi sonucu tanı konur. Fizik muayene bulgusu yok- sa radyolojik incelemede US ilk tercik edilen görüntüleme yöntemi olmalıdır [7]. Günümüz-de baryumlu inceleme nadiren kullanılmakta olup NG tüp ile yapılması tercih edilir.…”

“…Direkt batın grafisinde "çift kabarcık" (double bubble) bulgusu klasik görünümdür [8]. Benzer bulgu midgut volvulus, malrotasyon, annuler pankreas, duodenal web gibi patolojilerde de görüle-bildiği için seçilmiş olgularda tanıda kontrastlı radyografik incelemeler yarar sağlamaktadır [6,7,9]. Duodenal web: Direk grafide "çift kabarcık" bulgusu görülebilir.…”

Does Number of Ports affect Outcomes in Patients Undergoing Laparoscopic Pyloromyotomy? Retrospective Chart-Review Study

“…Infantile hypertrophic pyloric stenosis (IHPS) is a common condition affecting young infants; despite its frequency, IHPS has been recognized as a condition for only a little over a century and its etiology remains unknown [1]. Among the approaches used for pyloromyotomy are umbilical skin-fold incision [2] and laparoscopy [3].…”