eMedicine Specialties > Radiology > Pediatrics

Hypertrophic Pyloric Stenosis: Follow-up

Author: Janet R Reid, MD, FRCP(C), Associate Professor of Radiology, Section Head of Pediatric Radiology, Children's Hospital of Cleveland Clinic
Contributor Information and Disclosures

Updated: Aug 3, 2009

Intervention

Although surgical pyloromyotomy remains the definitive treatment for hypertrophic pyloric stenosis (HPS), small trials have reported the success of balloon catheter dilatation through an endoscope. The reliability of circular muscle disruption is unknown; in 2 of 6 patients in a small case series, incomplete disruption of the circular muscle ring was noted, and in 1 of 6 patients, a mucosal tear necessitated a full-thickness pyloric repair.25,26,27

Medicolegal Pitfalls

  • Failure to choose the best radiologic investigation for the vomiting infant
    • A thorough physical examination performed by a surgeon with pediatric expertise is required. A child with a palpable pyloric olive has hypertrophic pyloric stenosis (HPS); if imaging is still requested, confirm HPS by US. Following rehydration, perform pyloromyotomy when the child is clinically stable.
    • If the clinical history suggests HPS and the child is stable, perform US to diagnose or rule out HPS. If the US findings are negative, perform a UGI study to confirm or rule out other pathology.
    • If concern exists about malrotation, with or without volvulus (no olive is felt; patient is sick), a UGI study is necessary.
  • Failure to choose the best test, which is dictated by patient history, physical examination, and the surgeon's level of suspicion
  • US, although reliable for diagnosing HPS, may miss malrotation, which is the most serious cause of vomiting in infants. These children require a UGI examination.
 


More on Hypertrophic Pyloric Stenosis

Overview: Hypertrophic Pyloric Stenosis
Imaging: Hypertrophic Pyloric Stenosis
Follow-up: Hypertrophic Pyloric Stenosis
Multimedia: Hypertrophic Pyloric Stenosis
References
Further Reading
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References

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Further Reading

Related eMedicine topics

Pediatrics, Pyloric Stenosis (Emergency Medicine)

Pyloric Stenosis, Hypertrophic (Pediatrics)

Hypertrophic Pyloric Stenosis, Surgical Treatment (Pediatrics)

Evidence based clinical practice guideline hypertrophic pyloric stenosis. Cincinnati Children's Hospital Medical Center - Hospital/Medical Center.  2001 Aug 8 (revised 2007 Nov 4).  17 pages.  NGC:006224

Clinical guidelines

ACR Appropriateness Criteria® vomiting in infants up to 3 months of age. American College of Radiology - Medical Specialty Society.  1995 (revised 2005).  7 pages. [NGC Update Pending] NGC:004792

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Keywords

idiopathic hypertrophic pyloric stenosis, infantile hypertrophic pyloric stenosis, pyloric stenosis, HPS, IHPS, projectile vomiting, nonbilious infantile projectile vomiting

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Contributor Information and Disclosures

Author

Janet R Reid, MD, FRCP(C), Associate Professor of Radiology, Section Head of Pediatric Radiology, Children's Hospital of Cleveland Clinic
Janet R Reid, MD, FRCP(C) is a member of the following medical societies: American Association for Women Radiologists, American Society of Neuroradiology, Ohio State Medical Association, Radiological Society of North America, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Radiology
Disclosure: Nothing to disclose.

Medical Editor

Robert J Starshak, MD, Medical Director, Assistant Clinical Professor, Department of Radiology, Medical College of Wisconsin, Falls Medical Group
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

David A Stringer, MBBS, FRCR, FRCPC, Professor, National University of Singapore; Head, Diagnostic Imaging, KK Women's and Children's Hospital, Singapore
David A Stringer, MBBS, FRCR, FRCPC is a member of the following medical societies: British Columbia Medical Association, Canadian Association of Radiologists, European Society of Paediatric Radiology, Ontario Medical Association, Radiological Society of North America, Royal College of Physicians and Surgeons of Canada, Royal College of Radiologists, and Society for Pediatric Radiology
Disclosure: Sirius d'innovation None Board membership

CME Editor

Robert M Krasny, MD, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Clinical Director of Radiology and Consultant Radiologist, Department of Radiology, King's College Hospital, London
John Karani, MBBS, FRCR is a member of the following medical societies: British Institute of Radiology, British Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Gastrointestinal and Abdominal Radiology, European Society of Radiology, Radiological Society of North America, and Royal College of Radiologists
Disclosure: Nothing to disclose.

 
 
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