Ultrasound Diagnosis of Infantile Hypertrophic Pyloric Stenosis: Determinants of Pyloric Length and the Effect of Prematurity

doi:10.1053/crad.2001.0853

Clinical Radiology

Volume 57, Issue 2, February 2002, Pages 136-139

https://doi.org/10.1053/crad.2001.0853 Get rights and content

Abstract

AIM: To evaluate the determinants of sonographic measurements of pyloric length and muscle thickness in infants with hypertrophic pyloric stenosis (HPS) and to determine whether infants born prematurely have proportionately smaller measurements. MATERIALS AND METHODS: A retrospective review was carried out of 190 infants operated on for HPS at Bristol Children's Hospital over a 5-year period. Sonographic measurements of pyloric length and muscle thickness were related to age, history of prematurity, weight, sex and family history of HPS. RESULTS: Pyloric length in infants with HPS was significantly greater in those born at term compared to those born prematurely (18·6 mm [SD 2·2] vs 17·3 mm [SD 3·1], P = 0·043); this was explainable by body weight, with length increasing by 1·13 mm (SE 0·35) per kilogram (P = 0·002). There was no significant relationship with measured muscle thickness. CONCLUSION: Sonographic measurement of pyloric length is strongly correlated with the weight of the infant, irrespective of other factors. The relationship of length and weight may be useful in confirming the presence of HPS in small and premature infants Haider, N. et al. (2002). Clinical Radiology57, 136–139.

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Cited by (40)

Pediatric emergency gastrointestinal ultrasonography: pearls & pitfalls
2020, Clinical Imaging
Citation Excerpt :
However, the overall morphology of the pylorus may be more important than the measurements themselves in making the diagnosis of HPS. Several studies have shown that the muscle thickness and the channel length correlate with infant age and weight and that pyloric measurements for newborn infants younger than 21 days with intraoperatively proven HPS may be within the currently defined normal range [13–15]. In pylorospasm, the most common mimic of HPS, measurements can overlap with HPS although the muscle wall thickness will typically not exceed 3 mm [10].
Ultrasonography is an essential tool in pediatric imaging, particularly in the emergency setting. Although ultrasound is often the favored initial modality for abdominal imaging in children, it is highly operator-dependent and therefore prone to misinterpretation which can lead to false positive or negative exams, or even incorrect diagnoses. Conditions discussed in this series include ileocolic intussusception, hypertrophic pyloric stenosis, appendicitis, and ingested foreign bodies. We will review diagnostic criteria, highlight crucial findings, and illustrate commonly-encountered difficulties and mimics.
Early presenting hypertrophic pyloric stenosis with transient antroduodenal dysmotility in a preterm neonate: A case report
2015, Journal of Pediatric Surgery Case Reports
Citation Excerpt :
Cascio et al. reported that diagnostic USG measurements should remain the same for both preterm and term infants [7]. By contrast, Haider et al. showed that pyloric length strongly correlated with the weight of the infant, with length increasing by 1.13 mm per kilogram of weight [11]. A recent study by Said et al. showed that pyloric muscle thickness was directly related to weight but should not be an absolute criteria, because the smaller and younger infant with a clinical diagnosis of HPS may still have true HPS, even though the minimum criterion for muscle thickness or pyloric length was not found on USG [12].
Hypertrophic pyloric stenosis (HPS) is one of the most common gastrointestinal disorders that require surgical intervention in early infancy. Clinical presentation, diagnosis, and treatment have been well established in typical cases. We herein describe an unusual case of early presenting HPS with transient postoperative feeding intolerance after complete myotomy in a preterm newborn. An ex-31-week preterm newborn (birth weight, 1760 g) with persistent feeding intolerance since the first feeding was referred for surgery on the 7th day of life. Abdominal ultrasonography (USG) revealed an elongated pyloric channel (11 mm) with thickened pyloric muscle (2.1 mm). Laparotomy was performed and confirmed suspected HPS. Pylomyotomy was successful, but feeding intolerance persisted until postoperative day 12. USG on postoperative day 12 noted antroduodenal dysmotility, and transpyloric tube feeding was started. Full feeds were reached 8 days after tube feeding, which was then converted to full oral feeding. HPS should be considered in patients who show feeding intolerance shortly after birth. USG criteria for HPS in preterm infants has not yet been established. Transient antroduodenal dysmotility could be a reason for persistent feeding intolerance after complete myotomy in preterm infants, and transpyloric tube feeding could be a treatment in such cases.
Use of atropine sulfate in the treatment of infantile hypertrophic pyloric stenosis
2013, Journal of Taibah University Medical Sciences
Citation Excerpt :
The pylorus hypertrophies after birth and causes progressive gastric outlet obstruction, infants most commonly presenting this are between 2 and 6 weeks of age.3 The typical presentation is with projectile and non-bilious vomiting, which, if unrelieved, leads to progressive weight loss, dehydration and metabolic abnormalities.4 The exact etiology and pathogenesis are unknown, but the reason for clinical presentation is hypertrophy of the circular muscle layer of the pylorus, which causes gastric outlet obstruction.
مقارنة فعالية علاج التضيق البوابي الضخامي الطفلي باستخدام سلفات الأتروبين والتدخل الجراحي، مع إشارة خاصة إلى تراجع تضخم البواب.
تم معاينة 32 رضيعا تتابعا يعانون من تضيق البوابي في الفترة من يناير 2008 إلى يونيو 2011، وتم اختيار 28 حالة منهم عشوائيا. وشخصت جميع الحالات بالأشعة الصوتية. تكون العلاج الطبي من حقن الأتروبين عن طريق الوريد 0,01 مجم/كجم كل 4 ساعات، تلاها إعطاء الأتروبين عن طريق الفم 0,02 مجم/ كجم كل 4 ساعات، أما العلاج الجراحي فكان بطريقة "رامستد" المعتادة لبضع عضلة البواب تحت التخدير الكامل. تم قياس الاستجابة للعلاجين عن طريق التحسن السريري، وزيادة الوزن، وقياس سمك عضلة البواب وطول قناة البواب عن طريق الأشعة الصوتية.
تم علاج 14 طفلا رضيعا بالعلاج الطبي و 14 بالعلاج الجراحي. أدى العلاج الطبي إلى الشفاء التام لعدد 8 حالات من بين 12 رضيعا (66,6%) ، بينما العلاج الجراحي كان ناجحا لجميع الحالات وعددهم 14رضيعاً (100% ;0.05>p). كانت فترة الإقامة بالمستشفى 10±2 يوما في حال العلاج الطبي و3±1 يوما للعلاج الجراحي (0.0001=p).
يتفوق العلاج الجراحى على العلاج الطبي في حالات التضيق البوابي الضخامي الطفلي. ولكن معدل نجاح العلاج الطبي باستخدام سلفات الأتروبين يبرر استخدامه للرضع لمن لديهم موانع طبية للعلاج الجراحي وكذلك عندما يفضل الوالدين العلاج الطبي
To compare the efficacy of treatment of infantile hypertrophic pyloric stenosis with atropine sulfate and by surgery, with special reference to regression of pyloric hypertrophy.
Thirty-two consecutive infants with pyloric stenosis were seen between January 2008 and June 2011, and 28 cases were enrolled randomly. The diagnosis in all infants was confirmed by an abdominal ultrasound. Medical treatment consisted of intravenous atropine at 0.01 mg/kg every 4 h, followed by oral atropine at 0.02 mg/kg every 4 h. Surgical treatment consisted of standard Ramstedt’s pyloromyotomy under general anesthesia. The response to the two treatments was gauged from clinical improvement, weight gain and ultrasonic measurement of pyloric muscle thickness and pyloric canal length.
Fourteen infants were treated medically and 14 were given surgical treatment. Medical treatment resulted in complete cure in 8 of 12 infants (66.6%), whereas surgical treatment was successful in all 14 infants (100%; p < 0.05). The mean length of hospital stay was 10 ± 2 days for medically treated infants and 3 ± 1 days for those treated surgically (p = 0.0001).
Surgical treatment is superior to medical treatment in cases of infantile pyloric stenosis. The success rate of medical treatment with atropine sulfate nevertheless justifies its administration to infants in whom surgery is contraindicated and when medical treatment is preferred by the parents.
Infantile hypertrophic pyloric stenosis
2009, Journal de Pediatrie et de Puericulture
La sténose hypertrophique du pylore est une cause fréquente de vomissements chez le nourrisson, surtout le garçon. Sa pathogénie a donné lieu à de très nombreuses hypothèses et aucune d’entre elle n’est confirmée à ce jour. C’est une hypertrophie acquise de la musculeuse du canal pylorique, de type tumoral, globale, myomateuse qui entraîne une sténose centrée de la lumière du pylore. Cette hypertrophie s’étend à la paroi de l’antre prépylorique, créant un rétrécissement progressif serré, antropylorique étendu sur plusieurs centimètres. L’hypertrophie est sténosante, de consistance dure, presque calcaire, construisant sous la séreuse une masse ovalaire dont le pôle distal est saillant dans la lumière du bulbe duodénal alors que le pôle proximal est moins bien défini, n’apparaissant de façon nette que lorsque les ondes péristaltiques gastriques viennent buter sur sa rigidité en l’englobant. Les examens de pièces anatomiques ont permis d’observer constamment l’hypertrophie du muscle pylorique associée à un œdème de la muqueuse pylorique et, occasionnellement, des ulcérations.
Sonographic assessments of gastrointestinal and biliary functions
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Citation Excerpt :
However, episodes of duodenogastric reflux are physiological and it is difficult to define pathological conditions due to a broad overlap. Functional pre- and postprandial ultrasound is the method of choice for the diagnosis of IHPS [28]. Research agenda 2
Ultrasound has been established as a routine work-up imaging method in abdominal diseases. It assesses the morphology of intra-abdominal organs and depicts the normal and pathological anatomy of the gastrointestinal tract as well as of the biliopancreatic system. Ultrasound is the method of choice for visualisation of motion sequences since it is, in contrast to other imaging methods, a real-time method. The non-invasiveness and the repeatability of the method are important advantages when performing investigations of functional processes. Therefore, ultrasound is most suited for functional studies. Up to now, functional ultrasound and its potential have been undervalued. Functional ultrasound provides a widely available method to increase our understanding of functional processes and motility. The authors review the options of functional ultrasound and discuss its practical relevance.
Diagnostic accuracy of palpation and ultrasonography for diagnosing infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis
2022, British Journal of Radiology

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^f1: Author for correspondence and guarantor of study: Dr D. Grier, Department of Radiology, Bristol Children's Hospital, St Michael's Hill, Bristol, BS2 8BJ, U.K.

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Regular ArticleUltrasound Diagnosis of Infantile Hypertrophic Pyloric Stenosis: Determinants of Pyloric Length and the Effect of Prematurity

Abstract

Clin Radiol

Clin Radiol

Infantile hypertrophic pyloric stenosis: a review

Br J Surg

The genetics of infantile hypertrophic pyloric stenosis: a reanalysis

Am J Dis Child

Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis

Arch Dis Child

Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis

N Engl J Med

Hypertrophic pyloric stenosis in the infant without a palpable olive: accuracy of sonographic diagnosis

Radiology

Regular Article
Ultrasound Diagnosis of Infantile Hypertrophic Pyloric Stenosis: Determinants of Pyloric Length and the Effect of Prematurity