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PubMed1993

The increasing incidence of infantile hypertrophic pyloric stenosis.

Several reports have suggested that there is an increasing incidence of infantile hypertrophic pyloric stenosis (IHPS). We examined the incidence of IHPS in a stable population in the West of Ireland over a ten year period (1981-1990). During the 10 years of the study the number of live births per year did not alter significantly. The incidence of IHPS increased significantly from 0.87/1000 live births in 1981 to 5.10/1000 in 1990 (p < 0.001, Student's test), peaking in 1989 at 6.8/1000. There was no statistical correlation between the increasing incidence and feeding habits, birth rank, family history or gender distribution. The reason(s) for this increase remain unclear.

Female↗
PubMed1997

Prognostic factors of the postoperative vomiting in case of hypertrophic pyloric stenosis.

From January 1986 to February 1994, 198 children were operated on for hypertrophic pyloric stenosis (HPS). Postoperative follow-up have been carried out in 194 cases. The children were divided into two groups: group A (n = 134; 69.1%): without any postoperative diet troubles (n = 52) or simple regurgitations (n = 82), and group B (n = 60; 30.9%) presenting more significant vomiting requiring medical treatment (n = 52) or a prolongation of parental nutrition (n = 8). A retrospective study of the different factors which can possibly explain this postoperative vomiting was carried out. The criteria having an influence are: the age (44.5 days in group A; 35.7 days in group B; (p < 0.001) the weight at the time of the operation (3921) g in group A; 3647 in group B; p = 0.01) the thickness of the pylorus at the pre-operative ultrasound scan (5.2 mm in group A; 47 in group B; p < 0.015). The other studied criteria (prematurity, birth weight, delay in diagnosis, weight loss, hydroelectrolytic abnormalities, surgical approach way-subcostal or umbilical-, surgical difficulties and operation duration) are not statistically significant. The young age (and therefore the low weight) at the time of the pyloromyotomy can easily explain the post-operative vomiting through the physiological immaturity of the lower sphincter of the esophagus. It is more paradoxical to note that these difficulties are all the more frequent because the pyloric tumor is less thick at the ultrasound scan. But this criterion is also directly related to the child's age (average thickness of 4.5 mm before the age of one month and 5.8 mm after the age of two months; p < 0.0001). These data suggest the importance of systematic medical treatment to prevent postoperative vomiting in high-risk children, in order to decrease hospital stay (4.14 days in group A; 5.20 days in group B; p < 0.0001).

Female↗
PubMed1991

Audit of results of operations for infantile pyloric stenosis in a district general hospital.

Because of the proposal that infants with hypertrophic pyloric stenosis should only be treated by surgeons with an interest in paediatric surgery, we carried out a retrospective study to audit our experience in a district general hospital. Forty six infants over a five year period underwent pyloromyotomy. There were no deaths, and 36 infants (78%) made uneventful recoveries. Perforation of the duodenal mucosa occurred during the operation in 11 patients, and eight complications developed in six of these infants. There were seven wound infections, and two patients had vomiting that lasted four days or longer after their operations. There were no long term feeding problems. The results of this study show that such patients can be successfully treated in district general hospitals, and three areas merit special attention: meticulous surgical technique, the use of prophylactic antibiotics, and early graduated feeding.

Duodenum↗
PubMed1993

The genetics of infantile hypertrophic pyloric stenosis. A reanalysis.

OBJECTIVE: To determine whether the existing family data for infantile hypertrophic pyloric stenosis (IHPS) are sufficient for the purposes of establishing the mode of inheritance of this condition. DESIGN: Reanalysis of the familial aggregation patterns exhibited by IHPS, using data from several published family studies. CONCLUSIONS: Due to several limitations of the available family data for IHPS, the results of this analysis should be interpreted cautiously. Within the context of these limitations, the familial recurrence pattern among monozygotic cotwins and more remote relatives of IHPS probands was found to be inconsistent with generalized single major locus inheritance. The familial recurrence pattern of IHPS is, however, compatible with multifactorial threshold inheritance or the effects of multiple interacting loci. Under a model of multiple interacting loci, no single locus can account for more than a fivefold increase in the risk to first-degree relatives of IHPS probands. In contrast to several earlier reports, this analysis does not support the existence of a maternal factor that contributes to the risk of IHPS in the offspring of affected females.

Diseases in Twins↗
PubMed1986

A long-term gastrointestinal follow-up in patients operated on for congenital hypertrophic pyloric stenosis.

A gastrointestinal follow-up of 91 patients operated on for congenital hypertrophic pyloric stenosis (CHPS) between 1942 and 1964, using the Fredet-Ramstedt method, is presented. Among 85 patients available for follow-up, 72 responded to a request for reexamination. These patients were interviewed personally by one of the authors. Thirty-four patients (47%) consented to have a Roentgen examination done, performed as a double contrast study, investigating the structure and function of the stomach and duodenum. Forty-two patients (58%) had varying minor gastrointestinal complaints. Only two patients had severe symptoms. X-ray examination in 34 patients (47%) showed only three with pathological changes, i.e. one with mild deformation of the duodenal bulb, another with slight duodenal reflux. The third X-ray showed massive gastric retention with duodenal bulb deformation. The patient suffered from severe dyspepsia and vomitus. No correlation was found between the severity of the CHPS and the presence of later gastrointestinal symptoms. It is concluded that the Fredet-Ramstedt's operation for CHPS is an efficious operation with few perioperative complications and good long-term results.

Adult↗
PubMed1982

The incidence of coeliac disease and pyloric stenosis in children in Northern Finland.

The incidences of symptomatic coeliac disease (CD) and pyloric stenosis (PS) in children born 1960-1979 were studied retrospectively in Northern Finland. The total incidence of CD was 42.3, and of PS 122.7 per 100,000 live births. The figure for CD was lower than in studies from other industrial countries during the same period. The incidence of CD was highest in the early 1970s, and has decreased significantly, at least in children under two years of age, during the late 1970s. In the city of Oulu the incidence of CD was significantly higher than that in the surrounding countryside. Active search, with small intestinal biopsies, should reveal over 90% of cases with CD before the age of two years. Of 78 children diagnosed as having CD during the observation period, 75% were breast-fed for less than three months, 18% had signs of allergy at the time of diagnosis and seven % had IgA deficiency. In four patients CD was associated with diabetes. The incidence of PS varied from 107 per 100,000 live births in the early 1960S to 153 per 100,000 in the late 1960s. No significant seasonal variance was observed in the analysis of 226 children with PS in the study.

Adolescent↗
PubMed1997

Complications of pyloromyotomy for infantile hypertrophic pyloric stenosis.

BACKGROUND: Few references exist regarding contemporary complications of pyloromyotomy (PM) for infantile hypertrophic pyloric stenosis (IHPS). Therefore, we reviewed the frequency and outcome of patients with IHPS who developed complications from PM. METHOD: A 25-year retrospective review was performed in two populations. The first group included all infants who had a PM for IHPS at two pediatric surgery centers. The second group included all infants referred from other institutions who developed complications following PM for IHPS. RESULTS: Between 1969 and 1994, 901 PMs were performed. Intraoperative complications occurred in 40 patients (4%), including 39 duodenal perforations and 1 difficult intubation requiring prolonged ventilation. No unrecognized duodenal perforations or incomplete PMs were found. Postoperative complications developed in 52 patients (6%). The wound infection rate was less than 1%. Postoperative vomiting occurred in 31 infants (3%). The mortality rate was 0.1%, with 1 death due to sepsis from delayed diagnosis of Hirschsprung's disease. During the same study period, 11 patients were referred from other hospitals for postoperative complications. Five had persistent vomiting treated successfully with expectant management. Six infants needed reoperation: 3 for persistent IHPS, 1 for gastric outlet obstruction, and 1 for small bowel obstruction secondary to adhesions; 1 required wound abscess drainage. CONCLUSION: Pyloromyotomy is not without complications. Duodenal perforation should be infrequent, but when it occurs, it can usually be readily recognized and treated with minimal morbidity. Postoperative vomiting can be managed nonoperatively, but if it persists longer than 5 days, radiologic evaluation should be performed. Incomplete PM is uncommon and should not occur. A second myotomy is needed when the diagnosis of incomplete myotomy is established. A single standard of care should be expected of all surgeons who perform PM for IHPS.

Female↗
PubMed1984

Seromuscular laceration of the stomach associated with infantile hypertrophic pyloric stenosis in the newborn.

Two cases of seromuscular laceration of the stomach associated with infantile hypertrophic pyloric stenosis are reported. The diagnosis and treatment of this lesion is uncertain due to a paucity of clinical experience. The first patient was treated by mucosal resection. Early decompression therapy of the stomach is essential for the neonate with upper gastrointestinal obstruction or stenosis.

Humans↗