METABOLIC ALKALOSIS IN HYPERTROPHIC PYLORIC STENOSIS. CLINICAL SIGNIFICANCE AND TREATMENT

Is There a Relation Between Pyloric Muscle Thickness and Clinical and Laboratory Data in Infants with Hypertrophic Pyloric Stenosis?

Literature about the association between clinical and laboratory presentation and pyloric muscle thickness in infants with pyloric stenosis is lacking. The objective of this study is to examine the effect of pyloric muscle thickness on clinical and laboratory presentation in infants with pyloric stenosis. Thirty infants with hypertrophic pyloric stenosis presented at the Maternity and Children Hospital, Al-Madinah, Saudi Arabia, were included in this study analysis. Clinical and laboratory data of these infants were recorded. Statistical tests and univariate linear regression analyses were used as appropriate. P value was considered significant at a level ≤0.05. The mean age of the studied infant was 5.1 ± 2.6 weeks and mean weight was 3.4 ± 0.7 kg. Most of these infants were full-term (93.3 %), some presented to the hospital dehydrated (80 %), and some were lethargic (56.7 %). The mean pyloric muscle thickness among these infants showed statistically significant difference with regard to the studied clinical and laboratory data. A linear regression analyses also showed positive association between increasing pyloric muscle thickness and almost all studied clinical and laboratory data, with statistically significant difference observed for hyponatremia, hypochloremia, and high bicarbonates. The findings suggest that pyloric muscle thickness is a significant factor that determines the severity of clinical and laboratory presentation in infants with pyloric stenosis.

Infantile hypertrophic pyloric stenosis: the changing trend in treatment in a Danish county

From 1950 to 1984, 679 patients were treated for infantile hypertrophic pyloric stenosis (IHPS) in the County of Funen, Denmark. Medical treatment was performed in 114 patients and pyloromyotomy in 565. A pyloric tumor was palpated in 80% and a barium meal examination was performed in 24% of the patients. A shift toward intravenous fluid and general anesthesia is seen during the study period. Complications occurred in 17% of medically treated patients and in 8% of surgically treated patients. Six deaths occurred among the medically treated and four among the surgically treated patients. During the study period, a shift toward centralization and surgical treatment took place.

Infantile pyloric stenosis. A review of 200 cases

A series of 200 cases of infantile pyloric stenosis is presented. Amongst other clinical features reported are a family history of the condition in 6 per cent of the patients; a male: female ratio of 3.8: 1; no increased incidence amongst firsborn babies; no significant evidence of a seasonal variation; and a normal distribution of birth weights. 99.5 per cent were treated by a Ramstedt's pyloromyotomy with a mortality of 0.5 per cent. The duodenal mucosa was opened in 3.5 per cent and in 3.5 per cent there was no definite pyloric tumour at operation. The incidence of ruptured wounds was 1.5 per cent, of incisional hernias 3 per cent, and of some type of infection 14 per cent. The varying incidence of the condition in time and place, the aetiology, and the treatment are also discussed.