Abstract
BackgroundInfantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. There is paucity of published data regarding this condition in our setting. This study describes the clinical presentation, mode of treatment and outcome of treatment of this disease and identifies factors responsible for poor outcome of these patients.MethodsThis was a descriptive retrospective study of infants with HPS admitted to Bugando Medical Centre and subsequently underwent surgery between February 2009 and January 2014.ResultsA total of 102 patients (M:F = 4.7:1) were studied. The median age at presentation was 5 weeks. The median duration of illness was 4 weeks. Fifty-four (52.9 %) patients occur in first-born children. Associated anomalies were reported in 7 (6.9 %) patients. Non-bilious vomiting was the most frequent symptom and it was described in all (100 %) patients. A palpable mass was found in 23.5 % of infants. The diagnosis of IHPS was made clinically in 86 (84.3 %) and by ultrasound in 16 (15.7 %) patients. The treatment was Ramstedt’s pyloromyotomy in all cases. There were 6 (5.9 %) intra-operative mucosal perforations which were repaired successively. Postoperative complication was 11.8 %. The median length of hospital stay was 12 days and it was significantly associated with prolonged pre-operative hospitalization (p = 0.001). The mortality rate was 4.9 %. Age below 2 weeks, late presentation (≥14 days), severe dehydration on admission, hypokalaemia on admission and surgical site infection were the main predictors of mortality (p < 0.001).ConclusionThis study has shown that IHPS is a common condition in our setting. Age <2 weeks, delayed presentation, prolonged preoperative hospital stay, surgical site infection and high proportion of dehydration and electrolyte disturbance were the main predictors of poor outcome. A high index of suspicion is needed in infants with non-bilious vomiting to avoid delay in diagnosis.
Highlights
Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants
Infantile hypertrophic pyloric stenosis (IHPS) is a common infantile disorder characterized by enlarged pyloric musculature and gastric outlet obstruction [1]
In about 6–33 % of infants with IHPS, associated anomalies have been described in the central nervous system (CNS), gastrointestinal tract (GIT), and urinary tract [16]
Summary
Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. Infantile hypertrophic pyloric stenosis (IHPS) is a common infantile disorder characterized by enlarged pyloric musculature and gastric outlet obstruction [1]. It was first described as a disease entity in 1888 by Harald Hirschsprung [2]. IHPS occurs in approximately 1–4 per 1000 live births, rates and trends vary markedly from region to region [3, 4] It is more common in males than females (4:1–6:1) [3, 5] and in infants born preterm as compared with those born at term [6,7,8,9,10,11,12]. IHPS typically presents with progressive projectile non-bilious vomiting which
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