The Progressive Development of Pyloric Stenosis: A Role for Repeat Ultrasound

Keckler, Scott J.; Ostlie, Daniel J.; Holcomb, George; Peter, Shawn D. St.

doi:10.1055/s-2008-1038533

Cited by 8 publications

(3 citation statements)

References 15 publications

(10 reference statements)

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“…Cho đến nay không có báo cáo đầy đủ về chỉ số cơ môn vị đánh giá trên siêu âm cho trẻ sơ sinh non cân. Mặt khác mối lo ngại về kết quả âm tính giả trên siêu âm cũng được Keckler và các cộng sự lo ngại [7]. Việc thiết lập các tiêu chí chẩn đoán hẹp phì đại cơ môn vị ở trẻ sơ sinh non cân cần có số lượng bệnh nhân nhiều hơn.…”

Section: Bàn Luậnunclassified

Hẹp Phì Đại Cơ Môn Vị Ở Trẻ Sơ Sinh Non Tháng: Báo Cáo Ca Bệnh

Quỳnh¹,

Dư²,

Lâm³

et al. 2022

VMJ

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Hẹp phì đại cơ môn vị là một bệnh xảy ra ở tuần thứ hai sau sinh, không rõ nguyên nhân, bao gồm hẹp môn vị do phì đại cơ đồng tâm, gây tắc nghẽn đường ra dạ dày kèm theo nôn nhiều dần dẫn đến suy dinh dưỡng, mất nước, và rối loạn chuyển hóa nghiêm trọng. Hẹp phì đại cơ môn vị cực kỳ hiếm ở trẻ sơ sinh non tháng và hiếm khi được báo cáo trong y văn. Báo cáo này là của một trẻ sơ sinh non tháng, cân nặng lúc sinh thấp bị hẹp phì đại cơ môn vị. Bệnh nhân xuất hiện nôn ra sữa lúc 4 ngày tuổi, chướng bụng vùng thượng vị và có bóng dạ dày giãn trên phim X quang bụng. Trẻ được điều trị theo hướng trào ngược dạ dày thực quản nhưng bệnh không có tiến triển, trẻ vẫn nôn dịch sữa. Chụp lưu thông dạ dày-ruột chỉ thấy dạ dày giãn to. Siêu âm lại ổ bụng vào ngày thứ 10 thấy cơ môn vị dày. Bệnh nhân được phẫu thuật mở cơ môn vị bằng phẫu thuật mở. diễn biến sau mổ bệnh nhân tốt lên không nôn ra sữa. xuất viện sau 1 tuần.

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Section: Bàn Luậnunclassified

Hẹp Phì Đại Cơ Môn Vị Ở Trẻ Sơ Sinh Non Tháng: Báo Cáo Ca Bệnh

Quỳnh¹,

Dư²,

Lâm³

et al. 2022

VMJ

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“…У немовлят, у яких під час обстеження пілоричний м'яз мав товщину 2-4 мм і не розслаблювався упродовж обстеження, слід проводити обстеження в динаміці, про що наголошують й інші дослідники [7,10,13]. Особливої уваги потребують новонароджені, які народилися передчасно, оскільки в них ГПС розвивається в ті самі терміни, що і в новонароджених, які народилися вчасно, проте маса тіла в таких дітей менша, що може впливати на товщину пілоричного м'яза.…”

Section: результати дослідження та їх обговоренняunclassified

Ultrasonography in diagnostic of hypertrophic pyloric stenosis in children: advantages and pitfalls

Borova-Halay¹,

Malovanyy²,

Pereyaslov³

et al. 2022

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Hypertrophic pyloric stenosis (HPS) in newborns is the one of the most frequent causes of vomiting that required surgery. During long period of time, X-ray was the main method for the confirming diagnosis of HPS, however after first reports about possibilities of ultrasonography (US), this method was widely applied in clinical practice. Purpose - to summarize own experience of US applying for the diagnostic of HPS; determining advantages and disadvantages of this method of examination. Materials and methods. This study based on the US results of 93 patients with HPS and 27 children with pylorospasm that were observed and treated in Lviv regional children’s clinical hospital for 2009-2020 years. By US measured the thickness of pyloric muscle, length, front-posterior (transverse) size, and diameter of orifice of pyloric canal. Results of the study were evaluated by the statistical program StatPlus: mac, AnalystSoft Inc. (version v8). Results. The thickness of pyloric muscle and pyloric canal length are the major criteria of confirming/excluding HPS diagnosis. By the measurement of pyloric muscle thickness, it is necessary to remember that tangential position of transducer and muscles’ contraction can cause pseudo-thickening. According to the results of the study, the thickness of pyloric muscle in case of HPS was 6.4±0.3 mm (a range - 3-10 mm) and was no correlation nor with duration of illness (p=0.364) nor with age of child (p=0.534). In pylorospasm, which clinically can simulate HPS, the thickness of the pyloric muscle was 3.02±0.1 mm, what is significantly less compared to infants with HPS (Student’s t-test - 1.983; p=0.0000). Pyloric canal length in case of HPS was 22.9±0.6 mm (a range - 16-32 mm), what also was significantly differed than in case of pylorospasm - 15.8±0.5 mm (Student’s t-test - 1.998; p=0.0000). This was only indicator that clear correlated with child’s age (p=0.004) and duration of illness (p=0.006). Diameter of pyloric canal orifice and front-posterior size differed from indices in children with pylorospasm also. According to the results of ROC analysis, the best markers for the confirming diagnosis of HPS was thickness of pyloric muscle, its length, and front-posterior size, while the diameter of pyloric canal orifice shows the moderate prognostic significance. Conclusions. Ultrasonographic examination makes it possible to establish the diagnosis of HPS in newborns with a high degree of reliability. A doctor, who performs US in a child with suspected pylorostenosis, should be guided by the size of the unchanged pyloric canal and in case of its hypertrophy remember the «pitfalls» in the examination and know the ways to overcome them. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

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“…But these measurements are not the only criteria; some cases with pyloric enlargement may be due to intermittent spasm or thickening by mucosal swelling (e.g., after prostaglandin medication). In these situations functional observation is most helpful: observation of peristalsis and existing passage of stomach content through the intermittently open digestive canal with sufficient filling and distension of the duodenal bulb rules out HPS [15]. If US findings are evident, diagnosis is easy at first glance; in borderline cases, such as in early stages of the disease or in very small and younger neonates, a conservative observation approach with US follow-up will usually work [16,17].…”

Section: Specific Queries and Conditions In Pediatric Abdomen Assessablmentioning

confidence: 99%

Role and potential of modern ultrasound in pediatric abdominal imaging

Pilhatsch¹,

Riccabona²

2011

Imaging in Medicine

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REVIEWChildren and especially infants are not small adults -they suffer from specific diseases, present different imaging demands and have increased radiation sensitivity. One important aspect of ongoing continuous improvement of medical imaging is the increasing potential of ultrasound (US); this may help to minimize radiation by replacing or obviating other imaging. This important task, particularly in childhood, can only be achieved by providing dedicated skilled pediatric US to children 24 h, 7 days a week.The purpose of this review is to give some key advice on pediatric US, to list and illustrate typical pediatric conditions, to debate the relevant respective differential diagnoses and how US can reliably provide diagnostically relevant information with implications on therapy. For those who are familiar with pediatric radiology the following should be a useful review with some highlighted details. For everyone else this review should demonstrate what is achievable by modern US in children, completely different from the US potential in (obese) adult patients. We will aim to point out the significance of US in common and important pediatric abdominal queries and emphasize the difference between adults and children not only in terms of pathology, but also in the application and potential of the modality itself.Ultrasound (US) has gained its place as the preferred first-line imaging modality in the child's abdomen. Especially in infants US has advantages -the small amount of tissue and fat creating restrictions to CT and MRI allows for application of high-resolution (especially linear) transducers, offering excellent imaging capabilities; in addition, US is applicable at the bedside and can be performed without sedation. As radiation protection has become a key issue for imaging children, exploiting US to the utmost using all its possibilities and applying modern methods that have significantly widened US potential is an indispensable and increasingly important approach. This review illustrates standard US techniques, basic and new applications throughout the entire abdomen and its different organ systems, trying to point out the enormous potential of US in different clinical scenarios, focusing on gastrointestinal and urogenital issues. Future perspectives provided by new modalities such as contrastenhanced and 3D US will further strengthen the diagnostic value of this powerful imaging tool, hopefully contributing to continuing reduction of diagnostic radiation burden to children, by diminishing the need for CT. KEYWORDS: abdomen n children n gastrointestinal n infants n pediatric ultrasound n urinary tract

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The Progressive Development of Pyloric Stenosis: A Role for Repeat Ultrasound

Abstract: A negative pyloric sonogram may be due to the fact that the patient is in the very initial stages of development of pyloric stenosis. Caregivers should counsel parents to return if symptoms persist and there should be a low threshold for repeat ultrasound in these patients.

Cited by 8 publications

References 15 publications

Hẹp Phì Đại Cơ Môn Vị Ở Trẻ Sơ Sinh Non Tháng: Báo Cáo Ca Bệnh

Hẹp Phì Đại Cơ Môn Vị Ở Trẻ Sơ Sinh Non Tháng: Báo Cáo Ca Bệnh

Ultrasonography in diagnostic of hypertrophic pyloric stenosis in children: advantages and pitfalls

Role and potential of modern ultrasound in pediatric abdominal imaging

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