Hypertrophic pyloric stenosis in twins; genetic or environmental factors

Congenital Hypertrophic Pyloric Stenosis in a Preterm Dizygotic Female Twin Infant: Case Report

Infants with hypertrophic pyloric stenosis are usually diagnosed at about 3 to 8 weeks of age. The clinical onset of symptoms in preterm babies is observed normally at a later age than in term or post-term newborns. This report describes a rare case of a 2-day old preterm twin girl presenting with drinking laziness and recurrent vomiting. Five days after the beginning of symptoms and after several studies, including an upper gastrointestinal contrast study, the diagnosis of hypertrophic pyloric stenosis was made and confirmed at surgery. The postoperative course was uneventful. Interestingly, the mother of the child herself had a history of postnatal surgery on her fifth day of life due to congenital hypertrophic pyloric stenosis. To our best knowledge, this is the first report in the literature describing congenital hypertrophic pyloric stenosis in a mother and her child.

Hypertrophic pyloric stenosis case series in twins and first cousins: genes, feeding patterns or both? (a case report)

We present two cases of dizygotic male twins and two cases of male first cousins with infantile hypertrophic pyloric stenosis (IHPS). All patients were treated with open pyloromyotomy. No complications were reported. The patients had the same risk factors for IHPS. First, all patients were first-born white males. Second, the twins were preterm (35 weeks). Third, the twins and the first cousins were exclusively bottle feeding. Thus, a combination of genetic and environmental factors may have contributed to the appearance of IHPS.

Epidemiological and clinical characteristics of 304 patients with infantile hypertrophic pyloric stenosis in Anhui Province of East China, 2012-2015

OBJECTIVE

To analyze the clinical and epidemiological features of patients with infantile hypertrophic pyloric stenosis (IHPS) so as to provide scientific evidence for diagnosis and prevention of IHPS.

METHODS

We performed a retrospective study of infants with IHPS diagnosed from 2012 to 2015 at Anhui Provincial Children's Hospital. Demographic characteristics and clinical data were collected.

RESULTS

Three hundred four patients (264 males and 40 females) were studied, of which 94.7% were full term and 75.7% were bottle fed or mixed fed; 16.8% of the patients had other congenital malformations in combination with IHPS. The proportion of IHPS cases with hyponatremia, hypokalemia, and hypochloremia was 18.4%, 12.5%, and 53.9%. A negative correlation was found between duration of disease and serum electrolytes. The mean pyloric muscle thickness, pyloric length, and diameter were 4.8 ± 0.7 mm, 19.4 ± 2.5 mm, and 13.3 ± 1.8 mm, respectively. There were significant differences in muscle thickness, pyloric length, and diameter between short (≤14 d) and long (>14 d) durations of disease. All patients underwent pyloromyotomy, and postoperative recovery was good.

CONCLUSIONS

IHPS occurs mainly in male, full-term, bottle-fed or mixed-fed infants. Patients with long duration of disease were more likely to develop electrolyte disorder and thicker muscle layer. More attention should be paid to early discovery and diagnosis, which will help to improve the curative effect and prognosis of IHPS.