Pediatric Hypertrophic Pyloric Stenosis Workup

  • Author: Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: Mar 8, 2012
 

Laboratory Studies

  • Serum electrolytes: Document adequacy of fluid resuscitation and correction of electrolyte imbalances before surgical repair of hypertrophic pyloric stenosis (HPS). See Medical Care. Infants with severe vomiting can develop profound hypochloremia and hypokalemia. The classic biochemical abnormality in hypertrophic pyloric stenosis is hypochloremic, hypokalemic metabolic alkalosis.
Next

Imaging Studies

  • Ultrasonography has become the criterion standard imaging technique for diagnosing hypertrophic pyloric stenosis. It is reliable, highly sensitive, highly specific, and easily performed. An experienced ultrasonographer increases the test's predictive value. Necessary measurements include pyloric muscle thickness and pyloric channel length. Muscle wall thickness 3 mm or greater and pyloric channel length 14 mm or greater are considered abnormal in infants younger than 30 days.
  • Barium upper GI (UGI) study is an effective means of diagnosing HPS when ultrasonography is not diagnostic. It should demonstrate an elongated pylorus with antral indentation from the hypertrophied muscle. The UGI may demonstrate the "double track" sign when thin tracks of barium are compressed between thickened pyloric mucosa or the "shoulder" sign when barium collects in the dilated prepyloric antrum. After UGI barium study, irrigating and removing any residual barium from the stomach is advisable to avoid aspiration.
  • Although UGI endoscopy would demonstrate pyloric obstruction, physicians would find it difficult to differentiate accurately between hypertrophic pyloric stenosis and pylorospasm. Endoscopy is reserved for patients with atypical clinical signs when ultrasonography and UGI studies are nondiagnostic. Endoscopic dilatation has rarely been used as a method of treatment. This treatment is not standard for hypertrophic pyloric stenosis; endoscopy should be used rarely, if ever.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H  Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, Bushnaq Medical Centre, University of Jordan Faculty of Medicine, Jordan

Hisham Nazer, MB, BCh, FRCP, DCh, DTM&H is a member of the following medical societies: Royal College of Paediatrics and Child Health, Royal College of Physicians, Royal College of Surgeons in Ireland, Royal College of Surgeons of Edinburgh, and Royal Society of Tropical Medicine and Hygiene

Disclosure: Nothing to disclose.

Coauthor(s)

Dena Nazer, MD  Medical Director, Child Protection Center, Children's Hospital of Michigan; Assistant Professor, Wayne State University

Dena Nazer, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, and Helfer Society

Disclosure: Nothing to disclose.

Daniel A Beals, MD  Attending Staff, Cornerstone Pediatric Surgery

Daniel A Beals, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Surgical Association, American Society for Bioethics and Humanities, Kentucky Medical Association, Society for Fetal Urology, Society of Critical Care Medicine, and Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey J DuBois, MD  Chief of Children's Surgical Services, Division of Pediatric Surgery, Kaiser Permanente, Women and Children's Center, Roseville Medical Center

Jeffrey J DuBois, MD, is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, and California Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

B UK Li, MD  Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References

  1. Elinoff JM, Liu D, Guandalini S, Waggoner DJ. Familial pyloric stenosis associated with developmental delays. J Pediatr Gastroenterol Nutr. Jul 2005;41(1):129-32. [Medline].

  2. Chung E. Infantile hypertrophic pyloric stenosis: genes and environment. Arch Dis Child. Dec 2008;93(12):1003-4. [Medline].

  3. Kawahara H, Takama Y, Yoshida H, et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the "olive"?. J Pediatr Surg. Dec 2005;40(12):1848-51. [Medline].

  4. Panteli C. New insights into the pathogenesis of infantile pyloric stenosis. Pediatr Surg Int. Dec 2009;25(12):1043-52. [Medline].

  5. Alain JL, Grousseau D, Terrier G. Extramucosal pyloromyotomy by laparoscopy. Surg Endosc. 1991;5(4):174-5. [Medline].

  6. Siddiqui S, Heidel RE, Angel CA, Kennedy AP Jr. Pyloromyotomy: randomized control trial of laparoscopic vs open technique. J Pediatr Surg. Jan 2012;47(1):93-8. [Medline].

  7. Oomen MW, Hoekstra LT, Bakx R, Ubbink DT, Heij HA. Open Versus Laparoscopic Pyloromyotomy for Hypertrophic Pyloric Stenosis: A Systematic Review and Meta-Analysis Focusing on Major Complications. Surg Endosc. Feb 21 2012;[Medline].

  8. Georgeson KE, Corbin TJ, Griffen JW, Breaux CW Jr. An analysis of feeding regimens after pyloromyotomy for hypertrophic pyloric stenosis. J Pediatr Surg. Nov 1993;28(11):1478-80. [Medline].

  9. Alalayet YF, Miserez M, Mansoor K, Khan AM. Double-Y pyloromyotomy: a new technique for the surgical management of infantile hypertrophic pyloric stenosis. Eur J Pediatr Surg. Feb 2009;19(1):17-20. [Medline].

  10. Allan C. Determinants of good outcome in pyloric stenosis. J Paediatr Child Health. Mar 2006;42(3):86-8. [Medline].

  11. Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. Feb 2007;16(1):27-33. [Medline].

  12. Boneti C, McVay MR, Kokoska ER, Jackson RJ, Smith SD. Ultrasound as a diagnostic tool used by surgeons in pyloric stenosis. J Pediatr Surg. Jan 2008;43(1):87-91; discussion 91. [Medline].

  13. Copeland DR, Cosper GH, McMahon LE, Boneti C, Little DC, Dassinger MS. Return of the surgeon in the diagnosis of pyloric stenosis. J Pediatr Surg. Jun 2009;44(6):1189-92; discussion 1192. [Medline].

  14. Dahshan A, Donovan KG, Halabi IM, et al. Helicobacter pylori and infantile hypertrophic pyloric stenosis: is there a possible relationship?. J Pediatr Gastroenterol Nutr. Mar 2006;42(3):262-4. [Medline].

  15. Emil S. Pyloromyotomy through an infra-umbilical incision: open technique and superb cosmesis. Eur J Pediatr Surg. Apr 2009;19(2):72-5. [Medline].

  16. Finkelstein JB, Stamell EF, Zilbert NR, Ginsburg HB, Nadler EP. Management and outcomes for children with pyloric stenosis stratified by hospital type. J Surg Res. Jan 2010;158(1):6-9. [Medline].

  17. Gasseling J. Hypertrophic pyloric stenosis. Radiol Technol. Mar-Apr 2004;75(4):314-6. [Medline].

  18. Hall NJ, Eaton S, Pierro A. The evidence base for neonatal surgery. Early Hum Dev. Nov 2009;85(11):713-8. [Medline].

  19. Hall NJ, Pacilli M, Eaton S, Reblock K, Gaines BA, Pastor A. Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet. Jan 31 2009;373(9661):390-8. [Medline].

  20. Hall NJ, Van Der Zee J, Tan HL, Pierro A. Meta-analysis of laparoscopic versus open pyloromyotomy. Ann Surg. Nov 2004;240(5):774-8. [Medline]. [Full Text].

  21. Hernanz-Schulman M. Pyloric stenosis: role of imaging. Pediatr Radiol. Apr 2009;39 Suppl 2:S134-9. [Medline].

  22. Ibarguen-Secchia E. Endoscopic pyloromyotomy for congenital pyloric stenosis. Gastrointest Endosc. Apr 2005;61(4):598-600. [Medline].

  23. Leaphart CL, Borland K, Kane TD, Hackam DJ. Hypertrophic pyloric stenosis in newborns younger than 21 days: remodeling the path of surgical intervention. J Pediatr Surg. Jun 2008;43(6):998-1001. [Medline].

  24. Ly DP, Liao JG, Burd RS. Effect of surgeon and hospital characteristics on outcome after pyloromyotomy. Arch Surg. Dec 2005;140(12):1191-7. [Medline].

  25. Mullassery D, Perry D, Goyal A, Jesudason EC, Losty PD. Surgical practice for infantile hypertrophic pyloric stenosis in the United Kingdom and Ireland--a survey of members of the British Association of Paediatric Surgeons. J Pediatr Surg. Jun 2008;43(6):1227-9. [Medline].

  26. Rogers IM. The true cause of pyloric stenosis is hyperacidity. Acta Paediatr. Feb 2006;95(2):132-6. [Medline].

  27. Schwartz MZ. Hypertrophic Pyloric Stenosis. Pediatr Surg. 1998;1111-8.

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.