Conservative Management with Atropine Therapy for Infantile Hypertrophic Pyloric Stenosis

Abstract

Aim To study success rate efficacy and complications of atropine therapy in the management of Infantile Hypertrophic Pyloric Stenosis.Material and Method This prospective study was conducted over a period of 4 years from March 2016 to February 2020. 25 infants presented with diagnosis of Infantile Hypertrophic pyloric stenosis and subsequently managed conservatively with atropine were included in the study.The diagnosis of IHPS was made clinically by the typical clinical presentation of non-bilious vomiting gastric peristalsis or palpable pyloric mass and was confirmed with ultrasound.Atropine was initially administered intravenously in a dose of 0.06 mgkgday in eight divided doses in a day increased by 0.15 mgkgday till vomiting ceased and remained so for a period of 48 hours at a stretch and Ultrasonography showed a transit time of less than 1 minute.Oral feeding was started at a volume of 10 ml3 hourly 8 times a day. The volume was increased day by day until patients tolerated 150 mlkgday. Intravenous atropine was then substituted by oral atropine which was given at an initial dose of 0.05 mgkgd and increased to a maximum dose of 0.1 mgkgd for 3 weeks.Results A total 25 IHPS infants were admitted and managed with atropine therapy during the period of study. Out of 25 infants 22 88 were males and 0312 were females with a male to female ratio of 7.31. Mean birth weight of infants was 3.1plusmn1.4 kg. 20 80 infants were first-born children.Progressive non-bilious vomiting was the most frequent symptom and it was described in all 100 patients Visible peristalsis seen in 20 80 infants and A palpable mass was found in 1456 of infants. Metabolic alkalosis was seen in 1872 infants. Electrolyte abnormality seen in 20 80 infants in which Hyponatremia seen in 1872 Hypokalaemia seen in 16 64 Hypo chloremia seen in 16 64 infants.Of the 25 patients 20 became free from projectile vomiting during atropine treatment and treated successfully with atropine therapy. Five cases continued to vomit at least twice daily even after 12 days of IV treatment and ultimately opted out for pyloromyotomy after 12 days of intravenous atropine. Full feeding was achieved at 5- 4.3 days.Complications included transiently elevated heart rates 180-200 beatsmin in 0312 patients and facial flushing after the first dose of IV atropine in 01 4 patient. Mean duration of hospital stay was 10.36 plusmn 3.59 days range of 8 ndash16 days. There was no mortality in the study population.Conclusion Conservative Management with atropine therapy for Infantile Hypertrophic Pyloric Stenosis proved to be an effective and safe alternative to pyloromyotomy.