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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Pyloric stenosis is relatively common, with an incidence of approximately per 1, births, and has a male predilection M: It is more commonly seen in Caucasians 4and is less common in India and among black and other Asian populations.

While symptoms may start as early as 3 weeks, it typically clinically hipdrtrofi between 6 to 12 weeks of age. Clinical presentation is typical with non-bilious projectile vomiting. A succussion splash may be audible, and although common, is only relevant if heard hours after the last meal 6. Due to the loss of hydrochloric acid in the gastric contents from persistent vomiting, patients are at risk of electrolyte imbalance, specifically the characteristic hypochloraemic metabolic alkalosis.

Pyloric stenosis is the result of both hyperplasia and hypertrophy of the pyloric circular muscles fibres.

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The pathogenesis of this is not understood.

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis

There are four main theories Abdominal x-ray findings are non-specific but may show a distended stomach with minimal distal pyllrus bowel gas. On upper gastrointestinal fluoroscopy:. Ultrasound is the modality of choice in the right clinical setting because of its advantages over a barium meal are that it directly visualizes the pyloric muscle and does not use ionising radiation. Easy ultrasound technique hilertrofi to find gallbladder then turn the probe obliquely sagittal to the body in an attempt to find pylorus longitudinally 7.

The hypertrophied muscle is hypoechoic, and the central mucosa is hyperechoic. Diagnostic measurements include mnemonic ” number pi “:.

Initial medical management is essential with rehydration and correction pyloris electrolyte imbalances. This should be completed prior to surgical intervention.

Treatment is surgical with a pyloromyotomy in which the pyloric muscle is divided down to the submucosa.

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis

This can be performed both open and laparoscopically. The hkpertrofi is curative and has very low morbidity 4,5. Recurrence is rare and usually due to an incomplete pyloromyotomy There is usually little differential when imaging findings are appropriate.

Of course, clinically it is important to consider other causes of vomiting in infancy. The pylorus, however, appears sonographically normal.

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Gastro-esophageal reflux which represents the cause of vomiting in two-thirds of infants referred to radiology 8. To quiz yourself on this article, log in to see multiple choice questions. You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Unable to process the form. Check for errors and try again.

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Congenital Hypertrophic Pyloric Stenosis

Edit article Share article View revision history. Synonyms or Alternate Spellings: Hypertrophic pyloric stenosis Hypertrophic pyloric stenosis HPS. Support Radiopaedia and see fewer ads.

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