Surgical and pathological study of infantile hypertrophic pyloric stenosis in our locality

ABSTRACT

This study has included 80 newborns and infants [62 males and 18 females] suffering from infantile hypertrophic pyloric stenosis [IHPS]. The main presentation was repeated resistant vomiting, loss of weight, constipation or epigastric distention and the age of presentation was one week to five months. Fifty-eight out of 80 infants with IHPS [45 males and 13 females] were subjected to full history, thorough clinical examination and investigation in the form of pediatric endoscopy and gastrografin. From all patients, biopsy was taken from the hypertrophic layer of the pyloric antrum. The pattern of labeling in the myenteric nerve plexus layer is normal. Histochemical study revealed a marked reduction in fibers expressing nitric oxide synthase in the hypertrophic circular muscle, however, nitric oxide synthase was present in the myenteric plexus. The results have shown that the percentage of newborn with IHPS to live birth in the studied locality was 3/1000. In this study, 90% of patients had nitric oxide synthase loss in their histochemical studies of pyloric circular muscle. The management of such patients with surgical myotomy was file best procedure, while, laparoscopic or endoscopic dilatations are sill unsatisfactory to be the procedure of choice