1
|
Chiodi A, Escolino M, Di Mento C, Salvati V, Mazzone V, Esposito G, Porcaro M, Esposito C. Unusual late-onset hypertrophic pyloric stenosis in an adolescent girl with down syndrome: Case report and review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39096100 DOI: 10.1002/jcu.23777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
A 16-year-old girl with down syndrome came to our attention for recurrent postprandial vomiting and significant weight loss (>5 kgs). Diagnostic assessment (barium swallow study, ultrasonography, and CT) confirmed hypertrophic pyloric stenosis (HPS). Initial attempt with endoscopic dilation was not successful. The patient underwent Heineke-Mikulicz pyloroplasty. Full oral feeding was achieved by Day 7 postoperatively. At 6-month follow-up, the patient reported relief of symptoms, normal feeding habits and substantial weight gain. HPS should be considered in the differential diagnosis of recurrent vomiting, regardless of age. A comprehensive diagnostic work-up, including ultrasonography, endoscopy, and CT, is recommended to confirm the diagnosis.
Collapse
Affiliation(s)
- Annalisa Chiodi
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Maria Escolino
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Claudia Di Mento
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Vincenzo Salvati
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Valerio Mazzone
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| | - Giorgia Esposito
- Division of Internal Medicine, Federico II University Hospital, Naples, Italy
| | - Mauro Porcaro
- Division of Pediatric Radiology, Federico II University Hospital, Naples, Italy
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University Hospital, Naples, Italy
| |
Collapse
|
2
|
Iacoviello O, Verriello G, Castellaneta S, Palladino S, Wong M, Mattioli G, Giordano P, Francavilla R, Cristofori F. Case report: Late-onset hypertrophic pyloric stenosis in a 3-year-old boy: It is never too late. Front Pediatr 2022; 10:949144. [PMID: 36052362 PMCID: PMC9424671 DOI: 10.3389/fped.2022.949144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Hypertrophic Pyloric Stenosis (HPS) represents a relatively rare occurrence beyond infancy. Here, we present the case of a barely 3-year-old boy diagnosed with late-onset HPS and successfully treated with extra-mucosal pyloromyotomy. We review the literature, challenging the principle that more aggressive surgical approaches should be preferred over less invasive ones.
Collapse
Affiliation(s)
- Onofrio Iacoviello
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Giuseppe Verriello
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Stefania Castellaneta
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Stefano Palladino
- Department of Radiology, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Michela Wong
- Department of Pediatric Surgery, Istituto "Giannina Gaslini," University of Genoa, Genoa, Italy
| | - Girolamo Mattioli
- Department of Pediatric Surgery, Istituto "Giannina Gaslini," University of Genoa, Genoa, Italy
| | - Paola Giordano
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Ruggiero Francavilla
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| | - Fernanda Cristofori
- Department of Pediatrics, Ospedale Pediatrico "Giovanni XXIII," University of Bari, Bari, Italy
| |
Collapse
|
3
|
Liddick S. Gastric Outlet Obstruction Secondary to Pyloric Thickening in an Adolescent Male. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320912681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gastric outlet obstruction secondary to pyloric thickening in adolescents is an extremely rare finding. The condition is caused by a number of benign or malignant etiologies that cause an impediment to gastric emptying. Common and uncommon etiologies as well as the pathogenesis of gastric outlet obstruction are discussed. A case study of gastric outlet obstruction in a 14-year-old male is presented, and the crucial role of sonography in the diagnostic process of his condition is considered.
Collapse
Affiliation(s)
- Sonia Liddick
- Diagnostic Medical Sonography Program, El Centro College, Dallas, TX, USA
| |
Collapse
|
4
|
Banda FM, Mutapanduwa MG, Goutam C, Steenhoff A, Joel D. An unusual surgical cause of pyloric stenosis in an 8-month-old infant. Afr J Paediatr Surg 2017; 14:79-82. [PMID: 30688283 PMCID: PMC6369598 DOI: 10.4103/ajps.ajps_118_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Infantile hypertrophic pyloric stenosis (IHPS) is the most common surgical cause of nonbilious, projectile vomiting in children. Its incidence is estimated to be 2-5/1000 live births and has been noted to be quite rare in African-Americans, Asians, and Indians. It is more common in infants under 6 months of age and is quite rare in older infants. While IHPS is invariably intrinsic in nature, extrinsic pyloric stenosis is very rare. Children who present with nonbilious, projectile vomiting after the age of 6 months should, therefore, be thoroughly investigated for causes other than IHPS. This is a case report of an 8-month-old child who had a band of tissue constricting the pylorus which mimicked IHPS.
Collapse
Affiliation(s)
- Francis Msume Banda
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
| | - M G Mutapanduwa
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
| | - C Goutam
- Department of Surgery, Princess Marina Hospital, Gaborone, Botswana
| | - A Steenhoff
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
| | - Dipesalema Joel
- Department of Paediatrics and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
| |
Collapse
|
5
|
Parnall T, Caldwell K, Noel JM, Russell J, Reyes C. Hypertrophic pyloric stenosis in a 15-year-old male. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
6
|
Wolf LL, Nijagal A, Flores A, Buchmiller TL. Late-onset hypertrophic pyloric stenosis with gastric outlet obstruction: case report and review of the literature. Pediatr Surg Int 2016; 32:1013-6. [PMID: 27506212 DOI: 10.1007/s00383-016-3955-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
We report late-onset hypertrophic pyloric stenosis in a 17-year-old female. She presented with abdominal pain and an episode of upper gastrointestinal hemorrhage and subsequently developed gastric outlet obstruction. Work-up revealed circumferential pyloric thickening, delayed gastric emptying, and a stenotic, elongated pyloric channel. Biopsies showed benign gastropathy, negative for Helicobacter pylori, without eosinophilic infiltrates. Botulinum toxin injection provided limited relief. Diagnostic laparoscopy confirmed the hypertrophic pylorus and we performed laparoscopic pyloromyotomy. The patient tolerated the procedure well and had complete symptom resolution at 1-year follow-up. Hypertrophic pyloric stenosis is a rare cause of gastric outlet obstruction in adolescents and may be managed successfully with laparoscopic pyloromyotomy.
Collapse
Affiliation(s)
- Lindsey L Wolf
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA.
| | - Amar Nijagal
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alejandro Flores
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | | |
Collapse
|