Pediatric Hypertrophic Pyloric Stenosis Surgery Workup

  • Author: Michael S Irish, MD; Chief Editor: Marleta Reynolds, MD   more...
 
Updated: Apr 16, 2012
 

Laboratory Studies

Electrolyte panel

An electrolyte panel is essential for estimating the state of dehydration and acidosis/alkalosis in patients with pyloric stenosis.

Hypochloremic hypokalemic metabolic alkalosis is the characteristic biochemical disturbance observed in pyloric stenosis.

Liver function studies (not routinely obtained or necessary for diagnosis)

Jaundice occurs in approximately 2% of infants with pyloric stenosis. Although the cause is uncertain, this finding (similar to findings in Gilbert syndrome) is thought to reflect a decrease in hepatic glucuronosyltransferase activity associated with starvation, as occurs in high gastrointestinal obstruction. The jaundice resolves spontaneously and rapidly after pyloromyotomy.

Urinalysis

Urinalysis with normalization of urinary pH (correction of paradoxic aciduria) also helps determine adequacy of resuscitation.

Next

Imaging Studies

Radiography

Although a careful history and physical examination lead to diagnosis in the vast majority of patients with pyloric stenosis, those in whom a palpable mass is not identified require further diagnostic studies. Plain abdominal radiography may show a dilated stomach bubble, which suggests the diagnosis but should not be considered a diagnostic finding.

Upper GI series

Ultrasonographic examination has largely replaced upper gastrointestinal (UGI) contrast studies as the study of choice for confirming pyloric stenosis. Although UGI studies have been reported as yielding an accuracy of 96%, obvious disadvantages of such studies include radiation exposure and the risk of aspiration of contrast material.

A UGI study may be helpful in ruling out gastroesophageal reflux, duodenal atresia, and malrotation in cases in which uncertainty exists as to the nature of the emesis (ie, bilious versus nonbilious) and in which a pyloric mass is indiscernible.

Failure of gastric emptying demonstrated on UGI studies is not diagnostic of pyloric stenosis, because pyloric spasm and CNS lesions may be associated with delayed gastric emptying (see the image below).

Upper gastrointestinal study used for diagnosing pUpper gastrointestinal study used for diagnosing pyloric stenosis.

Ultrasonography

In 1977, Teele and Smith first described the use of ultrasonography in the diagnosis of pyloric stenosis.[9] Objective criteria in measuring the pylorus have increased the diagnostic accuracy of ultrasonography.

On ultrasonography, a diagnosis of pyloric stenosis can be made by identification of an elongated sausage-shaped mass with a pyloric diameter greater than 14 mm, a muscular thickness greater than 4 mm, and a length greater than 16 mm (see the image below).[10]

Longitudinal ultrasonogram of pyloric stenosis. PyLongitudinal ultrasonogram of pyloric stenosis. Pyloric stenosis is diagnosed by the demonstration of an elongated sausage-shaped mass with a pyloric diameter greater than 14 mm, a muscular thickness greater than 4 mm, and a length of more than 16 mm.

A sensitivity of 91%-100% and a specificity of 100% have been reported with these criteria. Ultrasonography is best performed with the stomach evacuated, as food or milk curds may interfere with the study. If a hypertrophied pylorus is not demonstrated on ultrasonographic examination, a UGI examination should follow to assess for other causes of vomiting.

Of note, Leaphart et al (2008) reported that ultrasonography in infants younger than 21 days may need revising with respect to muscle thickness. In their study of 314 newborns with hypertrophic pyloric stenosis, 60 (19%) were younger than 3 weeks, and 51 (85%) of were diagnosed with hypertrophic pyloric stenosis based on ultrasonographic findings. The mean muscle thickness in this subset was 3.7 mm, compared with 4.6 mm in those older than 3 weeks, which is concerning because the normal cutoff is less than 4 mm. Given a possible 1%-4% rate of negative exploration findings reported in the literature, the significance of these findings awaits further prospective research; however, this information could be useful in the assessment of borderline diagnoses.

Several recent studies support the premise that surgeons or even residents with appropriate resident-to-resident training may be adequately skilled to accurately diagnose pyloric stenosis. The advantages of this approach include a facilitated initial assessment and expedited management.

Previous
Next

Histologic Findings

Microscopically, circular muscle hypertrophies, with increased connective tissue in the septa between the muscle bundles. An increase in chondroitin sulphate within the extracellular matrix may account for the cartilaginous quality of the pyloric tumor. Note that histologic specimen is not obtained nor is it necessary for the diagnosis of pyloric stenosis.

Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Michael S Irish, MD  Adjunct Clinical Assistant Professor, Department of Surgery, University of Iowa, Roy J and Lucille A Carver College of Medicine; Consulting Pediatric Surgeon, Department of Pediatric Surgery, Blank Children's Hospital and Children's Hospital Physicians Group

Michael S Irish, MD is a member of the following medical societies: International Pediatric Endosurgery Group and Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

Philip M Bovet, DO, MPH, FACOFP  Resident Physician in Family Medicine, University of Wisconsin Health Clinic

Philip M Bovet, DO, MPH, FACOFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Osteopathic Association, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Aviva L Katz, MD  Assistant Professor of Surgery, University of Pittsburgh School of Medicine; Consulting Staff, Division of General and Thoracic Surgery, Children's Hospital of Pittsburgh

Aviva L Katz, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Pediatric Surgical Association, Association of Women Surgeons, Physicians for Social Responsibility, and Wilderness Medical Society

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.

Gail E Besner, MD  John E Fisher Endowed Chair in Neonatal Reseach, Director, Pediatric Surgical Research, Department of Surgery, Nationwide Children's Hospital; Professor of Surgery and Pediatrics, Department of Surgery, Ohio State University College of Medicine

Gail E Besner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Burn Association, American College of Surgeons, American Gastroenterological Association, American Medical Association, American Medical Women's Association, American Pediatric Surgical Association, Association for Academic Surgery, Federation of American Societies for Experimental Biology, Society of Critical Care Medicine, Society of Surgical Oncology, and Society of University Surgeons

Disclosure: Nothing to disclose.

H Biemann Othersen Jr, MD  Professor of Surgery and Pediatrics, Emeritus Head, Division of Pediatric Surgery, Medical University of South Carolina

H Biemann Othersen Jr, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American Cancer Society, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, American Society for Parenteral and Enteral Nutrition, American Surgical Association, American Thoracic Society, British Association of Paediatric Surgeons, Society for Surgery of the Alimentary Tract, Society of Critical Care Medicine, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association, Southern Society for Pediatric Research, and Southern Thoracic Surgical Association

Disclosure: Nothing to disclose.

Chief Editor

Marleta Reynolds, MD  Professor of Surgery, Northwestern University, The Feinberg School of Medicine; Head, Department of Surgery and Surgeon in Chief, Head, Division of Pediatric Surgery, Children's Memorial Hospital of Chicago

Marleta Reynolds, MD is a member of the following medical societies: American Pediatric Surgical Association

Disclosure: Nothing to disclose.

References

  1. Carter CO, Evans KA. Inheritance of congenital pyloric stenosis. J Med Genet. Sep 1969;6(3):233-54. [Medline].

  2. Pedersen RN, Garne E, Loane M, Korsholm L, Husby S. Infantile hypertrophic pyloric stenosis: a comparative study of incidence and other epidemiological characteristics in seven European regions. J Matern Fetal Neonatal Med. Sep 2008;21(9):599-604. [Medline].

  3. Cooper WO, Griffin MR, Arbogast P. Very early exposure to erythromycin and infantile hypertrophic pyloric stenosis. Arch Pediatr Adolesc Med. Jul 2002;156(7):647-50. [Medline].

  4. Huang PL, Dawson TM, Bredt DS, et al. Targeted disruption of the neuronal nitric oxide synthase gene. Cell. Dec 31 1993;75(7):1273-86. [Medline].

  5. Huang LT, Tiao MM, Lee SY, Hsieh CS, Lin JW. Low plasma nitrite in infantile hypertrophic pyloric stenosis patients. Dig Dis Sci. May 2006;51(5):869-72. [Medline].

  6. Everett KV, Chioza BA, Georgoula C, Reece A, Capon F, Parker KA, et al. Genome-wide high-density SNP-based linkage analysis of infantile hypertrophic pyloric stenosis identifies loci on chromosomes 11q14-q22 and Xq23. Am J Hum Genet. Mar 2008;82(3):756-62. [Medline].

  7. Jackson L, Kline AD, Barr MA. de Lange syndrome: a clinical review of 310 individuals. Am J Med Genet. Nov 15 1993;47(7):940-6. [Medline].

  8. Liede A, Pal T, Mitchell M. Delineation of a new syndrome: clustering of pyloric stenosis, endometriosis, and breast cancer in two families. J Med Genet. Oct 2000;37(10):794-6. [Medline]. [Full Text].

  9. Teele RL, Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med. May 19 1977;296(20):1149-50. [Medline].

  10. Bensard DD, Hendrickson RJ, Clark KS, Giesting KJ, Kokoska ER. Use of ultrasound measurements to direct laparoscopic pyloromyotomy in infants. JSLS. Oct-Dec 2010;14(4):553-7. [Medline]. [Full Text].

  11. Nagita A, Yamaguchi J, Amemoto K. Management and ultrasonographic appearance of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate. J Pediatr Gastroenterol Nutr. Aug 1996;23(2):172-7. [Medline].

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

  13. Tang KS, Huang IF, Shih HH, Huang YH, Wu CH, Lu CC, et al. Factors contributing to prolonged hospitalization of patients with infantile hypertrophic pyloric stenosis. Pediatr Neonatol. Aug 2011;52(4):203-7. [Medline].

  14. Tan KC, Bianchi A. Circumumbilical incision for pyloromyotomy. Br J Surg. May 1986;73(5):399. [Medline].

  15. Blumer RM, Hessel NS, van Baren R. Comparison between umbilical and transverse right upper abdominal incision for pyloromyotomy. J Pediatr Surg. Jul 2004;39(7):1091-3. [Medline].

  16. Alberti M, Cheli M, Locatelli G. A new technical variant for extramucosal pyloromyotomy, The Tan-Bianchi operation moves to the right. J Ped Surg. 2004;39:53-6. [Medline].

  17. Mullassery D, Shariff R, Craigie RJ, Losty PD, Kenny SE, Baillie CT. Umbilical pyloromyotomy: comparison of vertical linea alba and transverse muscle cutting incisions. J Pediatr Surg. Mar 2007;42(3):525-7. [Medline].

  18. Alain JL, Grousseau D, Terrier G. Extramucosal pylorotomy by laparoscopy. J Pediatr Surg. Oct 1991;26(10):1191-2. [Medline].

  19. Michalsky MP, Pratt D, Caniano DA. Streamlining the care of patients with hypertrophic pyloric stenosis: application of a clinical pathway. J Pediatr Surg. Jul 2002;37(7):1072-5; discussion 1072-5. [Medline].

  20. Puapong D, Kahng D, Ko A. Ad libitum feeding: safely improving the cost-effectiveness of pyloromyotomy. J Pediatr Surg. Dec 2002;37(12):1667-8. [Medline].

  21. Yoshizawa J, Eto T, Higashimoto Y. Ultrasonographic features of normalization of the pylorus after pyloromyotomy for hypertrophic pyloric stenosis. J Pediatr Surg. Apr 2001;36(4):582-6. [Medline].

  22. Pranikoff T, Campbell BT, Travis J. Differences in outcome with subspecialty care: pyloromyotomy in North Carolina. J Pediatr Surg. Mar 2002;37(3):352-6. [Medline].

  23. Safford SD, Pietrobon R, Safford KM. A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes. J Pediatr Surg. Jun 2005;40(6):967-72; discussion 972-3. [Medline].

  24. Hendrickson RJ, Yu S, Bruny JL, Partrick DA, Petty JK, Bensard DD. Early experience with laparoscopic pyloromyotomy in a teaching institution. JSLS. Oct-Dec 2005;9(4):386-8. [Medline].

  25. Yagmurlu A, Barnhart DC, Vernon A. Comparison of the incidence of complications in open and laparoscopic pyloromyotomy: a concurrent single institution series. J Pediatr Surg. Mar 2004;39(3):292-6; discussion 292-6. [Medline].

  26. Campbell BT, McLean K, Barnhart DC. A comparison of laparoscopic and open pyloromyotomy at a teaching hospital. J Pediatr Surg. Jul 2002;37(7):1068-71; discussion 1068-71. [Medline].

  27. [Guideline] International Pediatric Endosurgery Group. Guidelines for surgical treatment of infantile hypertrophic pyloric stenosis. Los Angeles, Calif: International Pediatric Endosurgery Group;. 2002;[Full Text].

  28. 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].

  29. Haricharan RN, Aprahamian CJ, Morgan TL, Harmon CM, Georgeson KE, Barnhart DC. Smaller scars--what is the big deal: a survey of the perceived value of laparoscopic pyloromyotomy. J Pediatr Surg. Jan 2008;43(1):92-6; discussion 96. [Medline].

  30. Cosper GH, Menon R, Hamann MS, Nakayama DK. Residency training in pyloromyotomy: a survey of 331 pediatric surgeons. J Pediatr Surg. Jan 2008;43(1):102-8. [Medline].

  31. Zhang YX, Nie YQ, Xiao X, Yu NF, Li QN, Deng L. [Treatment of congenital hypertrophic pyloric stenosis with endoscopic pyloromyotomy]. Zhonghua Er Ke Za Zhi. Apr 2008;46(4):247-51. [Medline].

  32. Abel RM. The ontogeny of the peptide innervation of the human pylorus, with special reference to understanding the aetiology and pathogenesis of infantile hypertrophic pyloric stenosis. J Pediatr Surg. Apr 1996;31(4):490-7. [Medline].

  33. Alain JL, Grousseau D, Longis B, et al. Extramucosal pyloromyotomy by laparoscopy. J Laparoendosc Surg. Mar 1996;6 Suppl 1:S41-4. [Medline].

  34. Ankermann T, Engler S, Partsch CJ. Repyloromyotomy for recurrent infantile hypertrophic pyloric stenosis after successful first pyloromyotomy. J Pediatr Surg. Nov 2002;37(11):E40. [Medline].

  35. Ashcraft KW, Holcomb GW III, Murphy JP. Lesions of the stomach, laparoscopy. In: Pediatric Surgery. 4th ed. Philadelphia, Pa: WB Saunders Co; 2005:407-10, 680-1.

  36. Atwell JD, Levick P. Congenital hypertrophic pyloric stenosis and associated anomalies in the genitourinary tract. J Pediatr Surg. Dec 1981;16(6):1029-35. [Medline].

  37. Banieghbal B. Rapid correction of metabolic alkalosis in hypertrophic pyloric stenosis with intravenous cimetidine: preliminary results. Pediatr Surg Int. Mar 2009;25(3):269-71. [Medline].

  38. Barksdale EM. Pyloric stenosis. In: Ziegler MM, ed. Operative Pediatric Surgery. Stamford, Conn: Appleton and Lange; 2003:583-8.

  39. Battaglia A, Chines C, Carey JC. The FG syndrome: report of a large Italian series. Am J Med Genet A. Oct 1 2006;140(19):2075-9. [Medline].

  40. Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics. 16th ed. 2000:1130-1.

  41. 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].

  42. Bufo AJ, Merry C, Shah R, et al. Laparoscopic pyloromyotomy: a safer technique. Pediatr Surg Int. Apr 1998;13(4):240-2. [Medline].

  43. Castanon J, Portilla E, Rodriguez E, et al. A new technique for laparoscopic repair of hypertrophic pyloric stenosis. J Pediatr Surg. Sep 1995;30(9):1294-6. [Medline].

  44. Caty MG, Azizkhan RG. Acute surgical conditions of the abdomen. Pediatr Ann. Apr 1994;23(4):192-4, 199-201. [Medline].

  45. Chaves-Carballo E, Harris LE, Lynn HB. Jaundice associated with pyloric stenosis and neonatal small-bowel obstructions. Clin Pediatr (Phila). Apr 1968;7(4):198-202. [Medline].

  46. Chuang JH, Chen MJ. Membranous atresia of esophagus associated with pyloric stenosis. J Pediatr Surg. Nov 1987;22(11):988-90. [Medline].

  47. Cook-Sather SD, Tulloch HV, Cnaan A. A comparison of awake versus paralyzed tracheal intubation for infants with pyloric stenosis. Anesth Analg. May 1998;86(5):945-51. [Medline].

  48. Croitoru D, Neilson I, Guttman FM. Pyloric stenosis associated with malrotation. J Pediatr Surg. Nov 1991;26(11):1276-8. [Medline].

  49. Desai K, Mazziotti M. Pediatric surgery, pyloromyotomy. In: Jones DB, Wu JS, Soper NJ, eds. Laparoscopic Surgery: Principles and Procedures. 2nd ed. New York, NY: Marcel Dekker, Inc; 2004:522.

  50. Dodge JA. Infantile hypertrophic pyloric stenosis in Belfast, 1957-1969. Arch Dis Child. Mar 1975;50(3):171-8. [Medline].

  51. Foulkes D. Clinical observations in dehydration. In: Gunn VL, Nechyba C, eds. Harriett Lane Handbook: A Manual for Pediatric House Officers. 2002. 16th ed. St Louis, Mo: CV Mosby Co; 235.

  52. Franken EA Jr, Saldino RM. Hypertrophic pyloric stenosis complicating esophageal atresia with tracheoesophageal fistula. Am J Surg. May 1969;117(5):647-9. [Medline].

  53. Fujimoto T, Lane GJ, Segawa O, et al. Laparoscopic extramucosal pyloromyotomy versus open pyloromyotomy for infantile hypertrophic pyloric stenosis: which is better?. J Pediatr Surg. Feb 1999;34(2):370-2. [Medline].

  54. Hamada Y, Tsui M, Kogata M, et al. Surgical technique of laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis. Surg Today. 1995;25(8):754-6. [Medline].

  55. Haricharan RN, Aprahamian CJ, Celik A, Harmon CM, Georgeson KE, Barnhart DC. Laparoscopic pyloromyotomy: effect of resident training on complications. J Pediatr Surg. Jan 2008;43(1):97-101. [Medline].

  56. Hollands CM, Tantoco J. Telerobotically-assisted pediatric surgery. In: Ballantyne GH, Marescaus J, Giulianotti PC, Marescaux J, eds. Primer of Robotic & Telerobotic Surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:181-6.

  57. Honein MA, Paulozzi LJ, Himelright IM. Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin: a case review and cohort study. Lancet. Dec 18-25 1999;354(9196):2101-5. [Medline].

  58. Keller H, Waldmann D, Greiner P. Comparison of preoperative sonography with intraoperative findings in congenital hypertrophic pyloric stenosis. J Pediatr Surg. Oct 1987;22(10):950-2. [Medline].

  59. Kelley RI. Smith-Lemli-Opitz syndrome. Baltimore, Md: Clinical Mass Spectrometry Laboratory. Kennedy Krieger Institute;1996. [Full Text].

  60. Klein A, Cremin BJ. Racial significance in pyloric stenosis. S Afr Med J. Oct 3 1970;44(39):1131. [Medline].

  61. Kol A, Steinman A, Levi O. Congenital pyloric stenosis in a foal. Isreal J Vet Med. 2005;60(2):59-62. [Full Text].

  62. Ladd AP, Nemeth SA, Kirincich AN. Supraumbilical pyloromyotomy: a unique indication for antimicrobial prophylaxis. J Pediatr Surg. Jun 2005;40(6):974-7; discussion 977. [Medline].

  63. 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].

  64. Mack HCA. A history of hypertrophic pyloric stenosis. Bull Hist Med. 1942;12:465-595.

  65. McVay MR, Copeland DR, McMahon LE, Cosper GH, McCallie TG, Kokoska ER, et al. Surgeon-performed ultrasound for diagnosis of pyloric stenosis is accurate, reproducible, and clinically valuable. J Pediatr Surg. Jan 2009;44(1):169-71; discussion 171-2. [Medline].

  66. Meeker CS, Denicola RR. Hypertrophic pyloric stenosis in a newborn infant. J Pediatr. Jul 1948;33(1):94-7. [Medline].

  67. Moore KL, Dalley AF. Abdomen. In: Clinically Oriented Anatomy. 4th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:231.

  68. Mullassery D, Mallappa S, Shariff R, Craigie RJ, Losty PD, Kenny SE, et al. Negative exploration for pyloric stenosis--is it preventable?. BMC Pediatr. Sep 24 2008;8:37. [Medline].

  69. O'Neill JA Jr, Grosfeld JL, Fonkalsrud EW. Hypertrophic pyloric stenosis. In: O'Neill JA Jr, Grosfeld JL, Fonkalsrud EW, Coran AG, Caldamone AA, eds. Principles of Pediatric Surgery. 2nd ed. St Louis, Mo: Mosby; 2003:467-70.

  70. Pickard RH. Hypertropic Pyloric Stenosis. Disease Topic 3463. MedPix Medical Imaging Database, Bethesda, MD;Departments of Radiology and Biomedical Informatics; Uniformed Services University: 2004. Available at http://rad.usuhs.mil/medpix/radpix.html?mode=single&comebackto=mode%3Dgeo_browse&recnum=3463.

  71. Ravitch M. The story of pyloric stenosis. Surgery. Dec 1960;48:1117-43. [Medline].

  72. Rowe MI, O'Neill JA, Grosfeld JL, et al. Hypertrophic pyloric stenosis. In: Rowe MI, ed. Essentials of Pediatric Surgery. St. Louis, Mo: Mosby Yearbook; 1995:481-5.

  73. SanFilippo A. Infantile hypertrophic pyloric stenosis related to ingestion of erythromycine estolate: A report of five cases. J Pediatr Surg. Apr 1976;11(2):177-80. [Medline].

  74. Schärli A, Sieber WK, Kiesewetter WB. Hypertrophic pyloric stenosis at the Children's Hospital of Pittsburgh from 1912 to 1967. A critical review of current problems and complications. J Pediatr Surg. Feb 1969;4(1):108-14. [Medline].

  75. Shuman FI, Darling DB, Fisher JH. The radiographic diagnosis of congenital hypertrophic pyloric stenosis. J Pediatr. Jul 1967;71(1):70-4. [Medline].

  76. Sitsen E, Bax NM, van der Zee DC. Is laparoscopic pyloromyotomy superior to open surgery?. Surg Endosc. Jun 1998;12(6):813-5. [Medline].

  77. Stang H. Pyloric stenosis associated with erythromycin ingested through breastmilk. Minn Med. Nov 1986;69(11):669-70, 682. [Medline].

  78. Tan HL, Blythe A, Kirby CP, Gent R. Gastric Foveolar Cell Hyperplasia and its Role in Postoperative Vomiting in Patients with Infantile Hypertrophic Pyloric Stenosis. Eur J Pediatr Surg. Feb 25 2009;[Medline].

  79. Tashjian DB, Konefal SH. Hypertrophic pyloric stenosis in utero. Pediatr Surg Int. Sep 2002;18(5-6):539-40. [Medline].

  80. Tiao MM, Tsai SS, Kuo HW, Yang CY. Epidemiological features of infantile hypertrophic pyloric stenosis in Taiwan: a national study 1996-2004. J Gastroenterol Hepatol. Jan 2011;26(1):78-81. [Medline].

  81. To T, Wajja A, Wales PW. Population demographic indicators associated with incidence of pyloric stenosis. Arch Pediatr Adolesc Med. Jun 2005;159(6):520-5. [Medline].

  82. Van der Horst R, Frankel J, Grace J. Congenital hypertrophic pyloric stenosis in phenotypic female twins with X-XX mosaicism. Arch Dis Child. Aug 1971;46(248):554-6. [Medline].

  83. Warner BW. Townsend CM, Beauchamp RD, Evers BK, Mattox K, eds. Sabiston Textbook of Surgery. 17th ed. Philadelphia, Pa: Saunders; 2004:2107-8.

  84. Yokomori K, Oue T, Odajima T, Baba N, Hashimoto D. Pyloromyotomy through a sliding umbilical window. J Pediatr Surg. Dec 2006;41(12):2066-8. [Medline].

 
Previous
Next
 
Diagram of the anatomic changes associated with pyloric stenosis.
Technique used for examining an infant with pyloric stenosis. The infant is best examined from the right, with mild pressure applied using the first 3 fingers of the right hand in a cephalad direction. Careful examination reveals an oblong, smooth, hard mass that is 1-2 cm in length. This mass is the hypertrophied pylorus and is commonly referred to as an olive.
Upper gastrointestinal study used for diagnosing pyloric stenosis.
Longitudinal ultrasonogram of pyloric stenosis. Pyloric stenosis is diagnosed by the demonstration of an elongated sausage-shaped mass with a pyloric diameter greater than 14 mm, a muscular thickness greater than 4 mm, and a length of more than 16 mm.
Open pyloromyotomy.
Laparoscopic pyloromyotomy.
empty para to satisfy content model
empty para to satisfy content model
empty para to satisfy content model
Table 1. Clinical Findings in Dehydrated Infants With Pyloric Stenosis
Level of DehydrationMildModerateSevere
Estimated Volume Deficit5% (50 mL/kg)10% (100 mL/kg)15% (150 mL/kg)
Clinical Findings
Skin (touch)NormalDry, paleClammy
Skin turgorNormalTentingNone
Mucus membranesMoistDryParched
EyesNormalDeep-setSunken
TearingPresentReducedNone
FontanelleNormal (flat)SoftSunken
CNSNormalIrritableLethargic/obtunded
Heart rateNormalSlightly increasedIncreased
Pulse qualityNormalWeakFeeble/impalpable
Capillary refillNormal~2 sec>3 sec
Urine outputNormalDecreasedAnuric
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.