Clinical Findings Versus Imaging Studies in the Diagnosis of Infantile Hypertrophic Pyloric Stenosis

Abstract

Background: Infantile hypertrophic pyloric stenosis is the commonest surgical cause of vomiting in early infancy and can be diagnosed clinically or by imaging studies.

OBJECTIVES: To assess the accuracy of clinical examination as compared with ultrasound and upper gastrointestinal contrast imaging in the diagnosis of infantile hypertrophic pyloric stenosis.

PATIENTS AND METHODS: A prospective study of 30 patients referred to the pediatric surgical department in pediatric teaching hospital in Erbil with a possible diagnosis of IHPS in the period from June 2006 to January 2009.

RESULTS:   The male to female ratio was 3.28:1 .The mean age at onset was 29.5 days. The mean age at presentation was 48 days. Projectile vomiting was present in all infants (100%).  Pyloric mass was palpable in 21 infants (70%). Visible peristaltic waves were noted in 12 infants (40%). 27 patients (90%) had gastric aspirate of more than 10cc. Ultrasound examination was confirmatory in 29 patients (96.6%). Barium study was positive in 27 cases (90%) and different signs were noted with various percentages. All patients underwent Ramstedt`s operation through right upper transverse incision. The average hospital stay was 3.5 days. The long term results in all the 30 cases were excellent.

CONCLUSION: A palpable pyloric mass with suggestive history is a sufficient indication for proceeding to surgical treatment without confirming diagnostic imaging studies. However, when physical findings alone are inconclusive, an upper gastrointestinal series or an abdominal ultrasound examination should be done because of their high sensitivity in identifying the underlying problems.

DOI: 10.7176/JHMN/76-04

Publication date:June 30th 2020