Guía de Práctica Clínica de estenosis hipertrófica del píloro / Clinical Practice Guidelines in Hypertrophic Pyloric Stenosis

La estenosis hipertrófica del píloro es una enfermedad que se presenta fundamentalmente en lactantes, ocurre por un estrechamiento del canal pilórico debido a la hipertrofia gradual de la capa muscular de su esfínter, lo que origina un síndrome pilórico. El objetivo de esta publicación es presentar una actualización sobre el tema. La etiología de la enfermedad es desconocida, la tendencia actual es que se trata de una enfermedad que no es congénita y se sugiere un origen multifactorial, donde influyen factores genéticos y ambientales. Su síntoma fundamental son los vómitos no biliosos y el diagnostico se complementa con el ultrasonido abdominal. El tratamiento de elección es quirúrgico y sus resultados generalmente satisfactorios. La aprobación de esta guía por los servicios de cirugía pediátrica del país la convierten en un útil instrumento asistencial y docente(AU)

Hypertrophic Pyloric Stenosis is a disease that occurs mainly in infants, caused by a narrowing of the pyloric channel due to the gradual hypertrophy of the muscle layer of the sphincter, which originates a pyloric syndrome. The aim of this publication is to present an update on the topic. The etiology of the disease is unknown, the current trend is that it is a disease that is not congenital and a multifactorial origin is suggested, where genetic and environmental factors influence. Its main symptom is non-bilious vomiting and diagnosis is supplemented with abdominal ultrasound. The treatment of choice is the surgical one and its results are generally satisfactory. The approval of this guidelines by the country's pediatric surgery services makes it a useful care and teaching tool(AU)

Clinical and laboratory features of hypertrophic pyloric stenosis

Hypertrophic Pyloric stenosis [HPS] is the most common surgical condition of stomach and duodenum which presents with intractable vomiting during the first weeks of life and death is unavoidable if left without treatment. This study aimed at evaluating the clinical and paraclinical characteristics of the disease in order to emphasize the importance of this potentially life threatening disease. In this retrospective study, from 1358 to 1382 hospital records of all the infants admitted in Shiraz university hospitals with the diagnosis of HPS were studied. From the 231 infants studied, 202 [87%] were male and 29 [13%] were female [male to female ratio of 8 to 1]. Ten cases [4.3%] had positive family history of the disease. 35 [15%] of them were the first child of the family. The onset of symptoms was between 2[nd] and 5[th] weeks of life in majority of the cases [75%]. Olive mass was observed in 116 [51%] of the cases, while constipation, bloody vomiting and jaundice were documented in 36%, 2% and 9% of the cases, respectively. Upper gastrointestinal series was diagnostic in 86% of the cases. However, abdominal sonography was helpful in only 88% of the cases. With proper observation and early diagnosis [by means of abdominal sonography] of patients suffering from repeated episodes of vomiting, the mortality and morbidity of this disease can be reduced

Usefulness of ultrasound in the diagnosis of infantile hypertrophic pyloric stenosis [IHPS]

The aim of our study was to know the diagnostic accuracy of ultrasonography in infantile hypertrophic pyloric stenosis [IHPS]. Material and This Prospective study of patients with clinical features suggestive of IHPS was carried out from January 2002 to December 2003 [2 years duration], at paediatrics surgery unit of Lady Reading Hospital Peshawar. Patients with clinical suspicion of IHPS were admitted through casualty, OPD and also shifted from other units. After clinical diagnosis of pyloric stenosis, ultrasound scanning was performed in all cases by a single experienced sonographer. All patients underwent surgery and pyloromyotomy was performed in all patients. Patients were followed up for at least 3 months. Twenty patients with clinical suspicion of IHPS were studied. The age ranged from 19 days to 120 days with average of 49 days. Male to female ratio was 19:1. The most common presenting symptom was nonbilious vomiting [100%]. Ultrasound revealed IHPS in all twenty cases. Surgery confirmed the findings of ultrasound scanning, showing 100% sensitivity of ultrasound in diagnosing IHPS. Pyloromyotomy was performed in all cases. There was no complication observed in this study. Ultrasound scanning is a useful tool of investigation and should be done in all suspected cases of IHPS to reduce the diagnostic errors leading to mismanagement