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At least 307 records · Page 17Linked to original sources
PubMed1982

Congenital hypertrophic pyloric stenosis--a 20-year review of 282 surgically treated infants.

A series of 282 children subjected to pyloromyotomy for congenital hypertrophic pyloric stenosis seen in the years 1961--1980 is presented. The various features relating to presentation, diagnosis and treatment are compared and contrasted in those treated in the first decade, 1961--1970 (series A) with those treated in the second decade, 1971--1980 (series B). It is noteworthy that there was an increased demand for radiological investigation in the second decade, and the fact that the number of patients diagnosed by radiological means only has doubled (from 9% to 19%) in the two series is probably a reflection of medical training and attitude. There was a marked decrease in the amount of post-operative vomiting during the second decade of this study and there was a slight tendency to earlier discharge from hospital in the latter years. The series confirms that congenital hypertrophic pyloric stenosis treated by pyloromyotomy has no mortality and only a minimal morbidity.

Female↗
PubMed1989

Myenteric plexus neuropathy in infantile hypertrophic pyloric stenosis.

The myenteric plexus and intramuscular nerve bundles in the circular muscle layer of the pylorus from 37 children with infantile hypertrophic pyloric stenosis (IHPS) obtained at pyloromyotomy were studied by light and electron microscopy and compared to six control cases without clinical evidence of IHPS. In certain IHPS cases degenerative alterations of the axons predominated. The axonal changes consisted of (1) severely increased variability of diameters with evidence of degeneration and regeneration of some axons, (2) accumulation of electron-dense bodies, lysosomes and pleomorphic membranous cytoplasmic bodies, (3) increase in the number of maloriented neurofilaments, and (4) aggregation of glycogen granules. Degenerative changes or immaturity of perikarya of neurons and glial cells in the myenteric plexus were not a significant feature. While axonal changes predominated in some IHPS cases there were severe changes of smooth muscle cells in others suggesting that a primarily neurogenic type of IHPS can be distinguished from a predominantly myogenic type. Although the etiology of the axonal changes in IHPS is not clear, it is suggested that they play an important role in the pathogenesis of pyloric stenosis and hypertrophy.

Female↗
PubMed1988

Pyloric stenosis in the sick premature infant. Clinical and radiological findings.

The clinical and radiographic features of five sick premature infants with idiopathic hypertrophic pyloric stenosis are presented. Clinical features were nonspecific, the common findings being recurrent nonbilious emesis, persistent abdominal distention, and the inability to place a nasojejunal feeding tube through the pylorus. Plain abdominal radiographs demonstrated persistent gastric dilatation in four of the infants. Idiopathic hypertrophic pyloric stenosis should be considered in the differential diagnosis of premature infants with upper gastrointestinal tract symptoms.

Diagnosis, Differential↗
PubMed1987

Ultrasonic "double track" sign in hypertrophic pyloric stenosis.

Ultrasound has been used in the diagnosis of hypertrophic pyloric stenosis since the first reports of its use with contact B mode scanners. Real-time imaging has allowed measurements of pyloric diameter, length, and muscle wall thickness. Wall thickness measurements taken with the pylorus in longitudinal (elongated) view improve diagnostic accuracy. Fluid aided real-time examination of 10 cases showed the ultrasound equivalent of the "double track" sign. This finding is the result of pyloric fluid compressed into smaller tracks as it is impinged upon circumferentially by the thickened circular muscle. This sign, previously seen in barium studies, although nonspecific, may prove to be a sensitive diagnostic criterion.

Female↗
PubMedDate not supplied

Treatment of adult pyloric stenosis: a pharmacological alternative?

Patients presenting with gastric outlet obstruction require investigation and treatment by surgery or balloon dilatation. This paper presents three cases of classic pyloric stenosis due to long-standing scarring from peptic ulceration. All cases were planned for active intervention but all settled, while investigations were in progress, with omeprazole. This would suggest that there are increasing numbers of such patients who are temporised with this treatment but may present again with refractile pyloric stenosis.

Aged↗
PubMed2000

[Infantile hypertrophic pyloric stenosis. A 25-year study from the county of Viborg].

In order to investigate an apparent decline in the incidence of infantile hypertrophic pyloric stenosis (IHPS), all cases of IHPS from 1973-1997 in the county of Viborg were studied retrospectively. One hundred and fourty-seven patients were found, with a significant decrease in incidence in the last five year period. Ninety-two percent were males, 14% had a family history of IHPS. Eleven percent had a birthweight < 2500 g, as opposed to 5-6% in the normal population. Pyloric stenosis presents in one to four weeks after birth in 70% and in 5-12 weeks in 28%. The diagnosis was reached solely through the the clinical picture in 105 cases. Twenty-three were examined with upper gastrointestinal radiography, six were false negative, abdominal ultrasound was performed in 21 cases and was false negative in four. Five patients were reoperated because of an inadequate first operation. Postoperative complications with wound infections were seen in eight patients. A high degree of accuracy of diagnosis can only be achieved through the clinical picture.

Birth Weight↗
PubMed1980

Congenital hypertrophic pyloric stenosis: a long-term follow-up of 41 cases.

From 1946 to 1977, 228 infants were operated on for congenital hypertrophic pyloric stenosis in the Tel-Aviv Municipal Medical Center, all by the method of Fredet-Ramstedt. An evaluation was made of the late morbidity in 41 patients, ranging in age from 15 to 30 years. The emphasis is on gastrointestinal diseases and their possible connection to the operation. Twenty-four of 41 patients had gastrointestinal symptoms, including dyspepsia, diarrhea, constipation, and abdominal pains. X-ray examination of the stomach was performed in 31 patients, in order to examine the structure and function of the stomach. Five patients showed clear signs of ulcer disease, four in the duodenum and one in the stomach. Another five patients showed mild deformation of the duodenal bulb, and two showed signs of gastritis. No correlation was found between the severity of the congenital pyloric stenosis and the presence of later illness or disturbances.

Adolescent↗
PubMed1999

Infantile hypertrophic pyloric stenosis: delays in diagnosis and overutilization of imaging modalities.

Infantile Hypertrophic Pyloric Stenosis (IHPS) can usually be diagnosed by the detection of a pyloric olive on examination performed by an experience examiner. In babies with typical symptoms and a palpable olive, no further confirmation of diagnosis is required. We retrospectively reviewed the diagnostic evaluations of 93 consecutive patients with proven IHPS. Many patients who had the diagnosis confirmed on physical examination underwent one or more unnecessary and redundant studies. The performance of these studies was associated with delayed diagnosis and possibly with adverse clinical health problems. An algorithm for management of patients with suspected IHPS is proposed. Prompt examination by an experienced examiner is key to the evaluation of such patients.

Algorithms↗
PubMed2001

Ultrasonographic features of normalization of the pylorus after pyloromyotomy for hypertrophic pyloric stenosis.

PURPOSE: The purpose of this study was to describe the time course, early postoperative changes, and morphologic features of normalization of the pylorus after pyloromyotomy for hypertrophic pyloric stenosis. METHODS: The subjects were 17 infants (9 boys, 8 girls) who underwent umbilical incision Ramstedt pyloromyotomy. The pyloric muscle mass was measured immediately before the operation and then at intervals from 3 days to 6 months after the operation using a 7.5-MHz ultrasound probe. RESULTS: In longitudinal section, the dorsal part of the pyloric muscle thickened transiently and then thinned to normal values by 5 months after the operation. It was 5.1 +/- 0.8 mm (mean +/- SD) preoperatively, increased to 6.0 +/- 0.3 mm by day 3 after the operation (P <.05), and thinned to 2.8 +/- 0.2 mm by 5 months after the operation. Concomitantly, the length of the pylorus gradually decreased (from 20.1 +/- 2.9 mm preoperatively to 16.9 +/- 2.7 mm by 3 days postoperatively [P <.05] and to less than 15 mm, by 4 months). In transverse section, the muscle normalized as in the longitudinal section. At the site of the incision it was 4.3 +/- 0.4 mm thick preoperatively, thickened to 4.6 +/- 0.4 mm by 3 days after the operation (P <.05), thinned to 2.1 +/- 0.9 mm by 7 days (P <.05), and then increased slightly, but always was less than 3.0 mm. Morphologically, in transverse section, the incised area looked like a wedge by 3 days after the operation. CONCLUSIONS: After pyloromyotomy for hypertrophic pyloric stenosis, there is an early transient increase in muscle thickness within the first few postoperative days followed by a slow decrease that reaches normal thickness (<3 mm) by 5 months. This decrease in thickness is accompanied by a gradual decrease in length to 75% of the preoperative value by 5 months. The morphologic features in this normalization are first a wedge (day 3), then a flat tire (days 7 and 14), and finally an elongated ring (5 months). J Pediatr Surg 36:582-586.

Digestive System Surgical Procedures↗
PubMed2006

Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital? Results from two teaching hospitals.

In order to document the incidence of perioperative complications in patients with infantile hypertrophic pyloric stenosis, a descriptive cohort study was performed in two teaching hospitals in the Netherlands. One hospital specialized in pediatric surgery and the other was a general surgery teaching hospital. All consecutive infants who underwent pyloromyotomy for the diagnosis hypertrophic pyloric stenosis in both hospitals between 1998 and 2002 were included. The children were diagnosed and treated according to a standard protocol. From all charts, complications durante- and post-operationem were recorded. A total of 256 pyloromyotomies were performed. Registered perioperative complications were duodenal mucosal perforation (n=6; 2%). Perioperatively unrecognized duodenal mucosal perforation occurred four times (1%). One re-operation was performed for an incomplete pyloromyotomy (0.3%). Persistent vomiting after the operation occurred in 18 children (7%). A large majority of postoperative complications were wound infections (n=16; 6%), 12 after right upper quadrant incision and 4 after umbilical incision; most of them were treated with antibiotics and/or incision for drainage of an abscess. An incisional hernia occurred four times. Prolonged vomiting was the only postoperative complication that differed significantly between the two teaching hospitals. The overall percentages of complications were equal to complication rates in literature, and since there were no extensive differences in major complications between the two teaching hospitals in this study, we can conclude that pyloromyotomy can be performed safely in specialized centers and in general centers provided with a multidisciplinary team.

Female↗
PubMed1998

Pyloric motor abnormality in patients with infantile hypertrophic pyloric stenosis.

There are no published data of manometric studies of pyloric motor function in patients with infantile hypertropic pyloric stenosis (IHPS). The present study attempted to examine the characteristics of motor abnormality of the pylorus in five children with IHPS. Using a transducer-built-in manometric catheter cannulated through the pylorus under fluoroscopy, the pressure in the pyloric canal was recorded continuously over 3 h during fasting. Clusters of high-amplitude spastic contractions of over 300 mmHg were recorded at intervals. The frequency was 1-3/min (mean 1.7 cpm) and the duration was 7-15 s. These periodic spastic contractions were suppressed temporarily for 20-30 min after intravenous injection of 0.01 mg/kg atropine. After pyloromyotomy, these spastic contractions decreased remarkably in amplitude, but there were no changes in frequency. It is concluded that the underlying motor abnormality observed in hypertrophied pyloric muscle is clusters of high-amplitude contractions, although more precise measurements of basal pyloric pressure are needed to explore the pathophysiology of IHPS in detail. The effect of pyloromyotomy may be related to the decrease in high-amplitude contractions.

Atropine↗
PubMed1995

[Outcome of hypertrophic pyloric stenosis after pyloromyotomy].

Twenty four patients diagnosed and operated of hypertrophic pyloric stenosis were examined by ultrasonography at diagnostic and sequential after pyloromyotomy. We measured pyloric diameter, thickness and length of the muscle and we calculated the pyloric volume. The overall configuration of the pylorus is more important than specific pyloric dimensions for diagnosis. The pyloric volume is the most discriminating criterion. Sequential sonograms at one and four months showed that all measurements fell to normal levels within four weeks, except pyloric volume.

Female↗
PubMed1996

Infantile hypertrophic pyloric stenosis after surgery for esophageal atresia with tracheoesophageal fistula.

Infants with esophageal atresia and tracheoesophageal fistula may have other associated anomalies. The development of infantile hypertrophic pyloric stenosis in the postoperative course of esophageal atresia with tracheoesophageal fistula is rarely reported. Because its symptoms may mimick postoperative complications such as gastroesophageal reflux or anastomotic stricture, the diagnosis may be delayed. We report an infant who had surgery for esophageal atresia with tracheoesophageal fistula at birth. The infant presented with nonbilious projectile vomiting at 4 weeks of age. Plain abdominal x-ray, barium upper gastrointestinal series and abdominal ultrasonography all supported the diagnosis of hypertrophic pyloric stenosis. The diagnosis was confirmed during surgery. After pyloromyotomy, the patient's condition improved.

Abnormalities, Multiple↗