Neonatal Emergencies II: Infantile Hypertrophic Pyloric Stenosis &amp; Intestinal Obstruction

Critical Factor ◽

Anorectal Malformations ◽

Duodenal Atresia ◽

Medical Emergency ◽

Rapid Sequence ◽

Intraoperative Management ◽

Infantile Pyloric Stenosis

This review focuses on the clinical presentation, diagnosis, preoperative stabilization and intraoperative management of infantile hypertrophic pyloric stenosis (IHPS) and neonatal gastrointestinal obstructions. IHPS poses medical emergency, which demands adequate preoperative optimization of the intravascular status and metabolic derangements before proceeding with surgery. In contrast, malrotation and volvulus require immediate surgical exploration under ongoing aggressive resuscitation in order to minimize further deterioration and preserve bowel length. Congenital anomalies, associated with disorders such as duodenal atresia, malrotation, volvulus, and anorectal malformations, warrant focused examinations to characterize the defect and severity of functional impairment, but they should not delay interventions for which time is a critical factor. This review contains 2 tables, and 41 references. Key words: neonatal, infantile pyloric stenosis, gastrointestinal, vomiting, metabolic, resuscitation, obstruction, malformation, apnea, rapid sequence.

Ultrasound and Infantile Pyloric Stenosis (IHPS) early Detection Better Patients

Annals of King Edward Medical University ◽

10.21649/akemu.v9i1.1299 ◽

2016 ◽

Vol 20 (3) ◽

Author(s):

Sajid Hameed Dar ◽

Sarfraz Ahmed ◽

Muhammad Afzal Sheikh

Keyword(s):

Early Detection ◽

Pyloric Stenosis ◽

Early Treatment ◽

Imaging Modality ◽

Easy Access ◽

Salient Features ◽

Infantile Pyloric Stenosis

The role of ultrasound in the diagnosis of Infantile Hypertrophic Pyloric Stenosis (IHPS) can not be over emphasized. The easy availability of this reliable imaging modality may contribute to prompter diagnosis and early treatment. The author wishes to present comparison of two series, of 52 patients each, conducted in the same department, but five years apart. Spread over more than a decade our experience with IHPS patients has undergone dramatic changes, especially the diagnostic part of it. Salient features of the two studies will be highlighted. In addition the study will examine whether the easy access to ultrasound has affected the care of infants with pyloric stenosis.

To Manage Infantile Hypertrophic Pyloric Stenosis by "Double-Y Pyloromyotomy" is a better Surgical Approach

Journal of Paediatric Surgeons of Bangladesh ◽

10.3329/jpsb.v1i2.19532 ◽

2014 ◽

Vol 1 (2) ◽

pp. 143-147

Author(s):

Md. Ansar Ali ◽

Kaniz Hasina ◽

Shahnoor Islam ◽

Md. Ashraf Ul Huq ◽

Md. Mahbub-Ul Alam ◽

...

Keyword(s):

Weight Gain ◽

Pyloric Stenosis ◽

Treatment Modalities ◽

Postoperative Vomiting ◽

Acid Base ◽

Feeding Regimes ◽

Acid Base Status ◽

Postoperative Feeding

Background: Different treatment modalities and procedures have been tried for the management of infantile hypertrophic pyloric stenosis. But surgery remains the mainstay for management of IHPS. Ramstedts pyloromyotomy was described almost over a hundred years ago and to date remains the surgical technique of choice. An alternative and better technique is the double-Y pyloromyotomy, which offer better results for management of this common condition.Methods: A prospective comparative interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. The study was designed that all patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy(DY) and the next by aRamstedts Pyloromyotomy (RP). Data on patient demographics, operative time, anesthesia complications, postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test.Results: From July 2008 through July 2010, fourty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group (1.21 ± 0.45days) vs Ramstedts pyloromyotomy (RP) group(3.03 ± 0.37days) p= 0.0001.Weight gain after 1st 10 days DY vs RP is ( 298 ± 57.94 gm vs193±19.8 gm p=0.0014), after 1 month (676.67±149.84 gm vs 466.67 ± 127.71 gm, p=0.0001), after 2months (741.33± 278.74 gm vs 490±80.62 gm, p=0.002) and after 3 months (582±36.01gm vs 453.33±51.64 gm, p=0.0001).No long-term complications were reported and no re-do yloromyotomy was needed.Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19532

Per-oral Pyloromyotomy for Treating Infantile Hypertrophic Pyloric Stenosis

Case Medical Research ◽

10.31525/ct1-nct04148040 ◽

2019 ◽

Author(s):

Keyword(s):

Pyloric Stenosis ◽

Per Oral

Faculty Opinions recommendation of Common variants near MBNL1 and NKX2-5 are associated with infantile hypertrophic pyloric stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14001975.793457612 ◽

2012 ◽

Author(s):

Deborah Gumucio ◽

Aaron Udager

Keyword(s):

Pyloric Stenosis ◽

Common Variants

Integrating genetics with newborn metabolomics in infantile hypertrophic pyloric stenosis

Metabolomics ◽

10.1007/s11306-020-01763-2 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

João Fadista ◽

Line Skotte ◽

Julie Courraud ◽

Frank Geller ◽

Sanne Gørtz ◽

...

Keyword(s):

Pyloric Stenosis ◽

Dried Blood Spots ◽

Population Based ◽

Case Control ◽

Sphincter Muscle ◽

Feeding Patterns ◽

Matched Case ◽

Selection Of

Abstract Introduction Infantile hypertrophic pyloric stenosis (IHPS) is caused by hypertrophy of the pyloric sphincter muscle. Objectives Since previous reports have implicated lipid metabolism, we aimed to (1) investigate associations between IHPS and a wide array of lipid-related metabolites in newborns, and (2) address whether detected differences in metabolite levels were likely to be driven by genetic differences between IHPS cases and controls or by differences in early life feeding patterns. Methods We used population-based random selection of IHPS cases and controls born in Denmark between 1997 and 2014. We randomly took dried blood spots of newborns from 267 pairs of IHPS cases and controls matched by sex and day of birth. We used a mixed-effects linear regression model to evaluate associations between 148 metabolites and IHPS in a matched case–control design. Results The phosphatidylcholine PC(38:4) showed significantly lower levels in IHPS cases (P = 4.68 × 10−8) as did six other correlated metabolites (four phosphatidylcholines, acylcarnitine AC(2:0), and histidine). Associations were driven by 98 case–control pairs born before 2009, when median age at sampling was 6 days. No association was seen in 169 pairs born in 2009 or later, when median age at sampling was 2 days. More IHPS cases than controls had a diagnosis for neonatal difficulty in feeding at breast (P = 6.15 × 10−3). Genetic variants known to be associated with PC(38:4) levels did not associate with IHPS. Conclusions We detected lower levels of certain metabolites in IHPS, possibly reflecting different feeding patterns in the first days of life.