Ultrasonography in the diagnosis of hypertrophic pyloric stenosis and intussusception: Emergency conditions in pediatric gastroenterology

Abstract

Hypertrophic pyloric stenosis (HPS) is the most common abdominal surgical condition in newborns and infants, while intussusception is the most frequent problem in children between the ages of 6 months and 2 years. The aim of this study was to show the advantages of ultrasonography in diagnosis of hypertrophic pyloric stenosis and intussusception and also to point out the efficiency of ultrasound guided hydrostatic reduction of childhood intussusception, as a nonoperative therapeutic option. This study had a prospective design and included 208 patients in a 2-year period (2004-2005). Both US examinations were done using a linear 7.5 MHz probe, and the main ultrasound criteria for HPS were increased pyloric muscle thickness of 3 mm and over, as well as pyloric length over 15 mm, typical ultrasonic findings of intussusception included a target sign or a pseudokidney sign. Sonographically guided hydrostatic reduction of intussusceptions was also performed. HPS was predominant in male infants, and the mean age was 40 days. The mean pyloric muscle thickness was 4.95 mm in infants with HPS, and the average length of the antroplyloric canal was 19.26 mm. In patients with intussusception, male predominance was also observed and the mean age was 1 year and 79 days. The intussusceptum was most often located in the cecoascending (53.6%) and transverse colon (21.4%). US-guided hydrostatic reduction of intussusception was successful in 82.14% of all cases. Our findings are in absolute agreement with literature data regarding the average age of patients, both with HPS and intussusception, thickness of the muscular layer, length of the antropyloric canal, and extremely successfid US-guided hydrostatic reduction of intussusceptions. Ultrasonography has proved to be a remarkably precise diagnostic modality in diagnosing HPS and intussusception, but also makes nonoperative treatment of intussusceptions possible in extremely high percentage.