scholarly journals Infantile Hypertrophic Pyloric Stenosis - Experiences of 77 Cases

1970 ◽  
Vol 6 (1) ◽  
pp. 2-4
Author(s):  
AC Paul ◽  
MJ Alam ◽  
MK Hassan ◽  
MA Hannan ◽  
NK Das ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Pyloric Stenosis ◽  
Hypertrophic Pyloric Stenosis ◽  
Barium Meal ◽  
Outlet Obstruction ◽  
Oral Feeding ◽  
Electrolyte Imbalance ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Female Ratio ◽  
Mucosal Perforation

Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants which needs surgical treatment. The aim of this study was to review the management of IHPS in our hospital to compare with other developed centers. This is a prospective analytical study carried out in the Department of Pediatric Surgery, Faridpur Medical College Hospital and Dr. Zahed Children Hospital at Faridpur, during the period of May 2002 to October 2010. Total 77 patients were treated by Ramstedt's pyloromyotomy after proper diagnosis and resuscitation. The male to female ratio was 10:1. Most of the patients presented to us within 40 days of age (90%).Younger one was 15 days and elder one was 69 days. In all cases diagnosis were done on clinical basis. The diagnosis is confirmed by barium meal x-ray in 71 cases and sonogram in 15 cases. Serum electrolytes were not estimated in all patients. There was moderate to severe dehydration in more than 60% cases. 71 cases were operated under general anesthesia and 06 cases were operated with local anesthesia. There was one postoperative death on 4th post-operative day. Oral feeding started after 8 to 10 hours postoperatively in all cases. Mucosal perforation occurred in 1 case and that was recognized and treated conservatively without any ill effect. Superficial wound infection encountered in 3 cases. Early diagnosis, preoperative correction of dehydration and electrolyte imbalance and experiences of surgeons play important role for management of IHPS. Key words: IHPS; Pyloromyotomy; Dehydration; Local anesthesia; Mucosal perforation. DOI: 10.3329/fmcj.v6i1.7401 Faridpur Med. Coll. J. 2011;6(1): 02-04

Infantile Hypertrophic Pyloric Stenosis Analysis of 84 Cases

1970 ◽  
Vol 18 (1) ◽  
pp. 14-16
Author(s):  
Md A Jafor ◽  
Md Latifur Rahman ◽  
KM Choudhury ◽  
Md A Hossain
Keyword(s):  
Hypertrophic Pyloric Stenosis ◽  
Barium Meal ◽  
Postoperative Mortality ◽  
Oral Feeding ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
College Hospital ◽  
Metabolic Derangement ◽  
Female Ratio ◽  
Superficial Wound ◽  
Mucosal Perforation

This is a descriptive study carried out in the Department of Pediatric Surgery, Rajshahi Medical College Hospital and in the private clinics of Rajshahi, during the period of November 2000 to October 2004. Total 84 patients were treated by Ramstedt's pyloromyotomy after proper resuscitation. The male to female ratio was 5:1. Most of the patients presented to us within 40 days of age (90%). In 90% cases diagnosis were done on clinical basis. The diagnosis is confirmed by barium meal x-ray in 60 cases and sonogram in 71 cases. Serum electrolytes were estimated in all patients. There was metabolic derangement in more than 80% cases. There was no postoperative mortality. Oral feeding started after 6 hours postoperatively in 81 cases. Inadvertent mucosal perforation occurred in 3 cases and that was recognized and repaired successfully without any ill effect. Superficial wound infection encountered in 8.33% cases. doi: 10.3329/taj.v18i1.3297 TAJ 2005; 18(1): 14-16

scholarly journals Ultrasonographic Evaluation in Early Diagnosis of Infantile Hypertrophic Pyloric Stenosis

2021 ◽  
Vol 28 (2) ◽  
pp. 208-211
Author(s):  
Gopal Chandra Saha ◽  
Prodip Kumar Biswas ◽  
Md Nasir Uddin ◽  
Sahadat Hossain ◽  
Nur Wa Bushra Jahan ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Pyloric Stenosis ◽  
Hypertrophic Pyloric Stenosis ◽  
Outlet Obstruction ◽  
Muscle Thickness ◽  
Electrolyte Imbalance ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Female Ratio ◽  
Pyloric Muscle ◽  
Pyloric Canal

Background: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants. This study was conducted to identify the accuracy of ultrasonography in the diagnosis of infantile Hypertrophic pyloric Stenosis. Methods: This cross-sectional descriptive. Study was conducted in Department of radiology and imaging, institute of child and mother health during two year period from 16th September 2016 to 16th September 2018. Fifty patients <8 weeks of age who presented with complaints of non-bilious vomiting were included in the study. Abdominal ultrasound was performed in all the cases. On ultrasonography pyloric canal length, diameter and pyloric muscle wall thickness was measured. Open surgery was performed as per indications and after informed consent. The pre-operative findings were compared with ultrasongraphic findings. Study variable were male to female ratio, percentage of cases in which pyloric mass was palpable. We also compare the duration of onset of symptoms with pyloric canal length, diameter and muscle thickness. Results: In this study, out of 50 patients, 46 (92%) were male and 4 (8%) were females. Gastric peristalsis was visible in 100% patients and mass was palpable in 14 (28%) patients. Pyloric canal length was more than standard in 98% cases; canal diameter was more than the standard in 87% cases and pyloric muscle thickness in 60% of cases. Ultrasonographic findings remained 98% accurate in this study. Conclusion: Ultrasonography is an investigation of choice for early diagnosis of IHPS before significant fluid and electrolyte imbalance occur. It is cost effective, harmless, freely available and easier to perform. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 208-211

scholarly journals Trends in the publication of infantile hypertrophic pyloric stenosis in Africa: A systematic review

2021 ◽  
Vol 2 ◽  
pp. 3
Author(s):  
Olakayode Olaolu Ogundoyin ◽  
Akinlabi Emmanuel Ajao
Keyword(s):  
Pyloric Stenosis ◽  
Case Reports ◽  
Hypertrophic Pyloric Stenosis ◽  
Case Series ◽  
Rare Condition ◽  
Operative Management ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Mucosal Perforation ◽  
Group A ◽  
Group B

There are still global variations in the epidemiology of infantile hypertrophic pyloric stenosis, although the clinical presentations may be similar. Outcome of management, however, may depend on the degree of evolution of management of the anomaly. This review aimed at evaluating the trends of reporting of infantile hypertrophic pyloric stenosis from Africa. An evaluation of all publications from Africa on infantile hypertrophic pyloric stenosis focusing on epidemiology, evolution of management of the anomaly was carried out. Literature search of all publications from Africa on Infantile hypertrophic pyloric stenosis was conducted from January 1, 1951, to December 31, 2018. The articles were sourced from the databases of African Index Medicus, OvidSP, PubMed, African Journal Online, and Google Scholar. Extracted from these publications were information on the type of article, trend of reporting, the country of publication, demographic details of the patients, number of cases, clinical presentation, pre-operative management, type of surgical approach, and the outcome of management. Overall, 40 articles were published from 11 countries. Of these, 16 (40.0%) were published in the first 35 years (Group A, 1951–1985) and 24 (60.0%) published in the later 33 years (Group B, 1986– 2018). Case reports 8 (20.0%) and case series 5 (12.5%) were predominant in Group A, whereas retrospective studies 12 (30.0%) predominated in Group B. The countries of publication included Nigeria (27.5%), South Africa (15.0%), Egypt (12.5%), Tanzania (10.0%), and Zimbabwe (10.0%). A total of 811 patients diagnosed and managed for infantile hypertrophic pyloric stenosis (IHPS) were reported. Their ages ranged from 1 day to 1 year with an incidence that ranged from 1 in 550 to 12.9 in 1000. There were 621 boys and 114 girls (M:F – 5.5:1). All the patients were breastfed with an average birth rank incidence of 42.4% among firstborns, 19.5% in second borns, 15.2% in third borns, 13.2% among fourth borns, and 10.0% among fifth borns and beyond. Associated congenital anomalies were reported in 5 (12.5%) studies with an incidence of 6.9–20% occurring in a total of 28 patients. All but 3 (7.5%) studies reported that open surgery was adopted to perform Ramstedt’s pyloromyotomy on the patients. Reported post-operative complications include mucosal perforation in 8 (20.0%) studies, surgical site infection in 7 (17.5%), gastroduodenal tear 2 (5.0%), and hemorrhage and incisional hernia in 1 (2.5%) study each. Mortality was reported in 26 (65.0%) studies with a range of 1.8–50% and a mean mortality rate of 5.2%. There has been a change in the trend of reporting IHPS in Africa over the years, with increasing comparative studies on the modalities of management compared to case reports and series. Still very limited work has been done in the aspect of genetics and etiology of IHPS among Africans. There is a need to increase funding in this regard and to encourage multi-center collaborations in the study of this relatively rare condition.

scholarly journals Pyloric stenosis at a tertiary hospital in Uganda

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Innocent Okello ◽  
Rovine Naluyimbazi ◽  
Alicia Massenga ◽  
Sarah Ullrich ◽  
Nasser Kakembo ◽  
...  
Keyword(s):  
Pyloric Stenosis ◽  
Hypertrophic Pyloric Stenosis ◽  
Surgical Care ◽  
Tertiary Hospital ◽  
Electrolyte Imbalance ◽  
Unknown Etiology ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Patient Records ◽  
Improved Outcomes ◽  
Late Referral

Abstract Background Worldwide, infantile hypertrophic pyloric stenosis has an incidence of 3 in 1000 livebirths, with an unknown etiology. Even when babies present with characteristic symptoms, it is often misdiagnosed leading to late referral for appropriate surgical care. The purpose of this study was to document our experience in management of pyloric stenosis within our setting. Results A total of 33 patient records were reviewed. All the patients presented with non-bilious vomiting. The ratio of males to females was 4.5:1. Of these patients, 76% had electrolyte imbalance with low chloride count in the majority of patients. All the patients underwent an open Ramstedt pyloromyotomy, and 91% had a good outcome. Conclusion Management of IHPS has very good outcomes in our setting. Earlier referral of patients leads to improved outcomes.

The Value of Ultrasound in the Diagnosis of Congenital Hypertrophic Pyloric Stenosis

1993 ◽  
Vol 32 (5) ◽  
pp. 281-283 ◽  
Author(s):  
Marcos Kovalivker ◽  
Ilan Erez ◽  
Nina Shneider ◽  
Ernesto Glazer ◽  
Ludwig Lazar
Keyword(s):  
Pyloric Stenosis ◽  
Gastric Outlet Obstruction ◽  
Clinical Picture ◽  
Hypertrophic Pyloric Stenosis ◽  
Barium Meal ◽  
Outlet Obstruction ◽  
Sonographic Diagnosis ◽  
Congenital Hypertrophic Pyloric Stenosis ◽  
Clinically Significant ◽  
Pyloric Muscle

The charts of 103 children with a clinically and surgically confirmed diagnosis of congenital hypertrophic pyloric stenosis were retrospectively reviewed. We found a significant correlation between sonographic and surgical measurements of the muscular thickness of the pylorus ( r = .987, P<.001). In 73.7% (76 cases), the clinical picture of gastric outlet obstruction was present when the thickness of the enlarged pyloric muscle was 3.0 mm or more. In 26.3% (27 cases), the pyloric muscle was less than 3.0 mm wide. For 10 patients in whom the muscle width was less than 2.5 mm by sonography, a barium meal was necessary to confirm the diagnosis. The width of the pyloric muscle is the most important factor in the sonographic diagnosis of pyloric stenosis, and even a width of less than 3.0 mm may be associated with clinically significant obstruction.

scholarly journals Postoperative gastric Outlet Obstruction following hiatal hernia repair in an infant: A case report

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Dr Muhammad Jawad Afzal ◽  
Shabbir Ahmad ◽  
Farrakh Mehmood Satar ◽  
Sajid Iqbal Nayyer ◽  
Muhammad Bilal Mirza ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Pyloric Stenosis ◽  
Gastric Outlet Obstruction ◽  
Hypertrophic Pyloric Stenosis ◽  
Outlet Obstruction ◽  
Hiatal Hernia Repair ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Intrathoracic Stomach ◽  
Case Presentation ◽  
Male Baby

Background: Infantile hypertrophic pyloric stenosis (IHPS) is an exceedingly rare cause of postoperative emesis in a case of hiatal hernia. Occasionally it may simulate other etiology of gastric outlet obstruction. Case Presentation: A 32-day-old male baby presented with respiratory distress and vomiting since birth. Diagnosis of eventration of left hemi diaphragm was made on CT Chest. At surgery, hiatal hernia with an intrathoracic stomach was found, which was repaired. On 5th postoperative day, the baby developed vomiting after feeding which gradually turned to be projectile in nature over a week. Contrast meal performed showed malpositioned stomach with delayed emptying. At re-operation, a well-formed olive of pylorus was encountered; Ramstedt pyloromyotomy was done. Postoperative course remained uneventful. Conclusion: IHPS is a rarely described association with hiatal hernia. Pyloric stenosis should be considered in differential diagnoses of postoperative emesis in infants with hiatal hernia.

scholarly journals INFANTILE HYPERTROPHIC PYLORIC STENOSIS (IHPS)

2015 ◽  
Vol 34 (2) ◽  
pp. 193
Author(s):  
Yusri Dianne Jurnalis ◽  
Yorva Sayoeti ◽  
Marlia Moriska
Keyword(s):  
Physical Examination ◽  
Clinical Manifestation ◽  
Pyloric Stenosis ◽  
Early Onset ◽  
Hypertrophic Pyloric Stenosis ◽  
Barium Meal ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Pyloric Region ◽  
Gastric Obstruction

AbstrakInfantile hypertrophic pyloric stenosis (IHPS) adalah kelainan anatomi pada bayi dengan terjadinya hipertropi pada region pilorik yang menimbulkan obstruksi. Diagnosis dapat ditegakkan berdasarkan manifestasi klinis. Pada kasus yang tidak khas dibutuhkan pemeriksaan lebih lanjut. Dilaporkan sebuah kasus IHPS di RS. M. Djamil Padang, anak laki-laki usia 2 bulan. Pasien datang dengan keluhan utama muntah yang tidak proyektil setiap selesai menyusui. Pada pemeriksaan fisik tidak ditemukan massa di abdomen sebagai tanda obstruksi. Dari pemeriksaan barium meal sesuai dengan IHPS dan terbukti saat operasi. Pasien pulang dalam keadaan baik.Kata Kunci : Infantile hypertrophic pyloric stenosis, barium mealAbstractInfantile hypertrophic pyloric stenosis (IHPS) is misleading anatomic in infant with hypertrophy muscle in the pyloric region leads to gastric obstruction. Diagnosed can determine based on the clinical manifestation. In the case that not characterized such as examination in early onset, onset in the younger ex neonate needs more examination to determine the case as IHPS. Reported a case IHPS in Dr. M. Djamil Hospital in infant, boy, 2 month old. He came with chief complain non projectile vomiting after feeding. In physical examination there was no palbable mass on the abdominal as manifestation of obstruction. The result of Barium meal appropriate with IHPS and was improved in operation. The patient was discharged in good condition.Key word : Infantile hypertrophic pyloric stenosis, barium mealLAPORAN KASUS

scholarly journals A clinical study of gastric outlet obstruction

2016 ◽  
Vol 4 (1) ◽  
pp. 264
Author(s):  
Suresh Clement H. ◽  
Ram Prasad Cherukumalli ◽  
Ch. Ravinder Rao
Keyword(s):  
Duodenal Ulcer ◽  
Pyloric Stenosis ◽  
Gastric Outlet Obstruction ◽  
Hypertrophic Pyloric Stenosis ◽  
Duodenal Bulb ◽  
Outlet Obstruction ◽  
Palliative Surgery ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Age Group ◽  
Carcinoma Stomach

Background:From the standpoint of pathology, the term pyloric stenosis is usually inaccurate at least in adult patients, since the site of obstruction is rarely situated at the pylorus itself but, is more often placed immediately proximal to the spinchter where the diagnosis of carcinoma is most probable or more distally in the duodenal bulb where the cause is almost invariably a duodenal ulcer. The aim was to study infantile hypertrophic pyloric stenosis, benign peptic ulcer and gastric carcinoma and evaluation of electrolyte abnormalities in gastric outlet obstruction, to study various modalities of treatment and to assess pertaining to recovery from paralytic ileus.  Methods: This was a clinical observational study comprising of 40 cases of gastric outlet obstruction. The patients for this study have been selected from Prathima Institute of Medical Sciences, Karimnagar, Telangana, India from December 2013- November 2015. The cases were selected who were willing to undergo surgery.Results:Congenital hypertrophic pyloric stenosis (CHPS) is more common among first born male infants. Parental consanguinity is associated with increased incidence of congenital hypertrophic pyloric stenosis. CHPS is common in the age group of first 3-6 weeks of life (average 4 weeks). Males are more commonly affected with gastric outlet obstructions in adults. Cicatrized duodenal ulcer is more common in the age group of 30-40 years, while carcinoma stomach is more common in age group of 50-60 years. Vomiting and visible gastric peristalsis are the most common and constant symptom and sign of gastric outlet obstruction, more so in cases of cicatrized duodenal ulcers.Conclusions:Ramstedt’s pyloromyotomy is the gold standard treatment for CHPS. Patients with gastric outlet obstruction due to cicatrized duodenal ulcer require truncal vagotomy with posterior gastrojejunostomy. Vagotomy is optional in view of better response with drugs for APD. Antral carcinoma cases require curative or palliative surgery depending on the stage of the disease.

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

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 ◽  
Hypertrophic Pyloric Stenosis ◽  
Treatment Modalities ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
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. Ramstedt’s 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 aRamstedt’s 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 Ramstedt’s 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

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