Abstract. In a large metropolitan general hospital, a high incidence of congenital hypertrophic pyloric stenosis was noted in non-Caucasian groups. Bile-free. Hypertrophic pyloric stenosis (HPS) refers to the idiopathic thickening of gastric pyloric musculature which then results in progressive gastric outlet obstruction. This is a condition that can affect babies in the first few weeks of life, usually at about 6 weeks. It tends to affect boys more than girls. Pyloric stenosis is a.

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Case 9 Case 9. Treatment is surgical with a pyloromyotomy in which the pyloric muscle is divided down to the submucosa. In the first week after surgery, the muscle can be the same thickness or even thicker than before surgery and then the dimensions gradually return to hipeertrofi. Reed AA, Michael K. A double internal layer of crowded and redundant mucosa may be identified Fig.

Case 11 Case A stomach completely filled with milk can also cause artefacts, other possibilities are to give the infant water or even to place a nasogastric tube, empty the stomach and then fill it with water.

When postoperative emesis is protracted, incomplete pyloromyotomy should be considered. Unequivocal palpation of a right upper quadrant mass was successful in less than half of the patients in this series, and radiographic studies were helpful in establishing the proper diagnosis in the remainder.

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis

Assess the appearance and measurements of the pylorus Fig. About Blog Go ad-free. It is important to carry out a systematic and dynamic study and to be aware stejosis the common technical difficulties and how to overcome them. Journal List Calif Med v. Read it at Google Books – Find it at Amazon.


Identification of the pylorus First step: The US examination allows the radiologist to perform a brief clinical history, which can reveal essential clues to the diagnosis. Having a systematic approach will improve the sensitivity of the technique.

Congenital Hypertrophic Pyloric Stenosis

Ohshiro K, Puri P. In the majority of cases of pylorospasm, the muscle is not hypertrophied. In premature infants, HPS develops at the same age as in term infants, but their smaller size should be taken into consideration.

The easiest way to avoid this is by placing the infant in an oblique position with the right side down, as this will allow fluid to fill the antrum, acting as an acoustic window. The operation is curative and has very low morbidity 4,5. Journal List Insights Imaging v.

Gastro-esophageal reflux which represents the cause of vomiting in two-thirds of infants referred to radiology 8. US also allows a dynamic study with direct observation of the pyloric canal morphology and behaviour. Of course, clinically it is important to consider other causes of vomiting in infancy. Associated Data Supplementary Materials.

Case 10 Case Observe the pyloric behaviour Third step: Synonyms or Alternate Spellings: While symptoms may start as early as 3 weeks, it typically clinically manifests between 6 to 12 weeks of age. In a large metropolitan general hospital, a high incidence of congenital hypertrophic pyloric stenosis was noted in non-Caucasian groups.


Common difficulties in performing the examination and tips to help overcome them will also be discussed. In HPS the thickened muscle and elongated pylorus are fixed over time, which helps the operator to identify this condition.

J Diagn Med Sonography. Initial medical management is essential with rehydration and correction of electrolyte imbalances. This should be completed prior to surgical intervention.

Clinical features HPS is the most common surgical cause of vomiting in infants. Diagnostic measurements include mnemonic ” number pi “:.

Congenital Hypertrophic Pyloric Stenosis

Imaging technique US is the first modality of choice when there is clinical suspicion of HPS, as it is non-invasive and does not use radiation, which is a crucial advantage in children. Ultrasonographic features of normalization of the pylorus after pyloromyotomy for hypertrophic pyloric stenosis.

Remember that a normal pylorus is much harder to visualise than a hypertrophied one. The condition plyorus characterised by thickening of the muscular layer and failure of the pyloric canal to relax resulting in gastric outlet obstruction.

New insights into the pathogenesis of infantile pyloric stenosis.