Congenital Hypertrophic Pyloric Stenosis Research Articles

Applications of gastric peroral endoscopic myotomy in the treatment of upper gastrointestinal tract disease.

Gastric peroral endoscopic myotomy (G-POME) is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tunnel around the pyloric sphincter. In 2013, Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy, providing a new direction for the treatment of gastroparesis. With the recent and rapid development of G-POME therapy technology, progress has been made in the treatment of gastroparesis and other upper digestive tract diseases, such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture, with G-POME. This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.

Gastric Peroral Endoscopic Pyloromyotomy for Infants With Congenital Hypertrophic Pyloric Stenosis: Ready for Prime Time?

1Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. Correspondence: Petar Mamula, MD. E-mail: [email protected].

Gastric peroral endoscopic pyloromyotomy for the treatment of congenital hypertrophic pyloric stricture in an infant with a self-made bite block.

Gastric per-oral endoscopic myotomy (G-POEM) is reported to be a promising treatment for refractory gastroparesis, on the other hand, it is also an effective treatment for congenital hypertrophic pyloric stenosis (CHPS). Here, we want to report a case in which G-POEM was performed in an infant with CHPS.

Development of the submucosa and musculature in the human fetal stomach: A microscopic study

Background: Development of the human fetal stomach starts at the 4th week of intrauterine life. The knowledge of histogenesis of the musculature of the stomach is important for understanding, diagnosis, and treatment of gastric adenomyoma, congenital anomalies like congenital hypertrophic pyloric stenosis, and abnormalities in the development of the enteric nervous system. The aim of this study was to find out the histogenesis of the submucosa (SM), muscularis mucosa (MM), and muscularis externa (ME) in the human fetal stomach. Methodology: Sixty-three freshly aborted fetuses which were free from any gross abnormality were collected from the obstetrics and gynecology department and studied for 2 years. The fetuses were dissected, the stomach was removed, and the tissue was processed for a histological study. Staining was done by hematoxylin and eosin, Masson's trichrome, and Van Gieson's stain. Slides were studied under Zeiss branded light microscope using ×10 and ×40 objectives. Results: MM was discontinuous initially and became well defined by 21 weeks in the fundus and body and by the 23rd week in the pyloric region. The density of collagen fibers increased gradually in SM and was seen in bundles from the 23rd week onward. The thickness of SM was more than ME till 22 weeks, and after 27 weeks, it was less than that of ME. In the fundus and body of the stomach, till 18 weeks, ME consisted of two layers, with the inner oblique layer being thicker than the circular layer. The circular layer thickened gradually, and the longitudinal layer appeared by the 25th week. In the pyloric region, initially, there was only a circular layer. The oblique and longitudinal muscle layers appeared at 17–18 weeks and 25th week, respectively. The thickness of the circular layer was found to be more than that of the body from the 21st week onward and became much thicker at around the 27th week. The histological feature of MM, ME, and SM of the stomach resembled an adult pattern by the 28th week of gestational age. Conclusion: The findings of the present study about the time of appearance and further development of MM and ME and the thickness and formation of SM of the human fetal stomach are quite comprehensive. These findings are expected to aid in the knowledge of histogenesis of the stomach in the human fetuses and help in the diagnosis and treatment of various congenital anomalies and clinical conditions involving gastric connective tissue and musculature.

Diagnostic Accuracy of Acid-Base Status in Infants with Hypertrophic Pyloric Stenosis.

Hypertrophic pyloric stenosis is a condition in newborns in which the hypertrophic pyloric muscle causes gastric obstructive symptoms of progressive vomiting leading to hypochloremic hypokalemic metabolic alkalosis. The main aim of the research was to assess whether, based on the acid-base status, we can distinguish newborns who vomit due to pylorostenosis, compared with newborns who vomit for other unspecific reasons. The electronic records of patients in the hospital information system treated under the diagnosis Q40.0 (Congenital hypertrophic pyloric stenosis) (n = 69/included in the study = 53) in the period from 1 January 2014 to 1 January 2022 were reviewed retrospectively. For the purposes of the control group, the electronic records of patients treated in the emergency department with a diagnosis of R11.0 (Nausea and vomiting) (n = 53) without an established cause were randomly reviewed. In addition to the main aim, other research outcomes were to determine differences between groups in the following variables: duration of symptoms, family history, birth (preterm, term, post-term), birth weight, weight during examination, difference between birth weight and weight during an examination, type of vomiting, the thickness of the muscle wall and its length, and to calculate whether there is a correlation between the thickness and length of the pylorus muscle and the duration of vomiting in relation to variables from acid-base status. In relation to the variables of interest between the groups, statistically significant differences were observed in the duration of symptoms (Mdn 4 vs. 2 days, p = 0.002), weight at examination (Mean 3880 vs. 4439 g, p = 0.001), difference in weight between birth and examination (Mean 374 vs. 1010 g, p < 0.0001), and type of vomiting (explosive 45 vs. 22, p = 0.023). In the acid-base status between the groups, a statistically significant difference was recorded for pH (Mdn 7.457 vs. 7.422, p < 0.0001), bicarbonate (Mdn 25 vs. 23 mmol/L, p = 0.000), total carbon dioxide (Mdn 25 vs. 24 mmol/L, p = 0.011), base excess (Mdn 0.8 vs. -1.3 mmol/L, p = 0.000), potassium (Mdn 5 vs. 5.3 mmol/L, p = 0.006), ionized calcium (Mdn 1.28 vs. 1.31 mmol/L, p = 0.011), and glucose (Mdn 4.5 vs. 4.9 mmol/L, p = 0.007). Regardless of the group, the correlations between the duration of vomiting (r = 0.316, p = 0.021 vs. r = 0.148, p = 0.290) and the thickness (r = 0.190, p = 0.172) and length (r = 0.142, p = 0.311) of the pylorus muscle in relation to pH did not exist or were weak. In a world where radiological methods are not equally available everywhere, with promising acid-base indicators, prospective multicenter studies and meta-analyses must be pursued in the future in order not to miss the possible much greater diagnostic potential of acid-base status.

Per Oral Pyloromyotomy for Treatment of Gastroparesis in a Pediatric Patient

Per Oral Pyloromyotomy for Treatment of Gastroparesis in a Pediatric Patient

Gastric peroral myotomy (G-POEM) in patients with delayed emptying function of the stomach

Introduction. Disorders in the gastric evacuation function are met in patients with gastroesophageal reflux. In most cases, simultaneous laparoscopic pyloroplasty can solve the problem. As an alternative to surgical pyloroplasty to treat gastroparesis, a new technique has been proposed – peroral submucosal pyloromyotomy or gastric peroral endoscopic myotomy (G-POEM). Recently, this endoscopic surgery has been implemented in adults and in newborns with congenital hypertrophic pyloric stenosis to treat gastric paresis. In the present work, the authors describe this technique and short-term results after G-POEM in a child who had previously been operated on for gastroesophageal reflux.Material and methods. Peroral submucosal pyloromyotomy was performed in a girl of 5 y.o. with impaired motor-evacuation function of the stomach after surgical treatment of gastroesophageal reflux disease at the age of two . For 3 years, the child had therapy which included antiemetics and H2-receptor blockers. However, clinical symptoms constantly recurred, and it was decided to make a thorough examination of the patient. At the contrast examination of upper gastrointestinal tract, stomach enlargement and slow transit of the contrast preparation into the duodenum were seen. Fibrogastroduodenoscopy confirmed the normal function of the fundoplication cuff and found a cause of impaired gastric emptying. A contracted gastric outlet as a spasmodic pylorus was found to be an obstacle for normal stomach evacuation function. A narrow hole in the pylorus was found. A 5.4 mm gastroscope could pass through it. The patient had a complete peroral endoscopic submucosal pyloromyotomy. The technique of this surgery consisted in creating a submucosal tunnel at 4 cm before the pylorus and in dissecting the hypertrophied muscle layer by Ramstedt incision using an electrocoagulation knife. After the end of surgery, the incision on the mucous layer was closed with special clamps.Results. Surgical time lasted for 45 minutes. There were no intraoperative complications: bleedings and mucosal perforation . The patient began to eat in 6 hours after the surgery. The transition to full enteral feeding lasted for 24 hours. The child was discharged from the hospital next day in good condition. At the follow-up examination 6 months after surgery, the girl had weight and height typical for her age. There were no signs of dysphagia, abdominal distension, nausea and vomiting any more . There were no post-operative scarring on the child’s abdominal wall.Conclusion. Peroral submucosal pyloromyotomy is technically implementable, safe and effective for treating disorders of stomach evacuation function in children. Further research is needed to find the place of this technique in the treatment of gastric outlet obstruction.

Leveraging a phenome-wide approach to identify novel exposure-birth defect associations: A proof of concept using maternal smoking and a spectrum of birth defects.

There are often questions about the impact of exposures on a range of birth defects, but there are few rigorous approaches for evaluating these associations. Using maternal smoking as an example we applied a phenome-wide association study (PheWAS) approach to evaluate the impact of this exposure on a comprehensive range of birth defects. Cases were obtained from the Texas Birth Defects Registry for the period 1999-2015. A total of 127 birth defects were examined. Maternal smoking at any time during the pregnancy was ascertained from the vital record. Data were randomly divided into discovery (60%) and replication (40%) partitions. Poisson regression models were run in the discovery partition, using a Bonferroni threshold of p < 3.9×10-4 . Birth defects passing that threshold in adjusted models were evaluated in the replication partition using p < 0.05 to determine statistical significance. Four birth defects were positively and significantly associated with maternal smoking in both partitions: cleft palate, anomalies of the pulmonary artery, other specified anomalies of the mouth and pharynx, and congenital hypertrophic pyloric stenosis. Obstructive defects of the renal pelvis and ureter showed consistent negative associations. All five defects exhibited significant dose-response relationships. We demonstrated that a statistically rigorous approach can be applied to birth defects registry data to examine the association between specified exposures and a range of birth defects. While we confirmed previously reported associations, others were not validated, likely due to misclassification in exposure based on vital records.

Clinical Outcomes of Surgical Treatment of Hypertrophic Pyloric Stenosis &#x0D; with Application of Various Operational Access

Introduction. Treatment options of congenital hypertrophic pyloric stenosis (HPS) appear to be an acute issue nowadays due to the fact that this pathology is often detected in children of the first year of life - according to statistics, the incidence rate of congenital hypertrophic pyloric stenosis in children is 3:1000 live newborns. Since there are various treatment options of the given congenital pathology, there is no general consensus in the opinions of surgeons regarding the superiority of different treatment methods. Therefore, it is necessary to search for a single most relevant treatment technique for this pathology.The aim of the study was to analyze clinical outcomes for treatment of congenital hypertrophic pyloric stenosis in children with application of various surgical techniques: open pylorotomy (transverse, circumbilical incision) and laparoscopic pylorotomy.Materials and methods. The study included 67 patients, who received treatment in Kursk Regional Pediatric Hospital №2 in 2014-2018. Patients with congenital HPS were divided into 3 groups, depending on the performed surgical interventions. Group 1 included patients who underwent an open pylorotomy with transverse access, group 2 included patients who underwent an open pylorotomy with circumbilical access, and group 3 included patients who underwent laparoscopic pylorotomy. The following parameters were used to assess the efficiency of the treatment performed: the duration of the operative intervention, the duration of stay of a child in the ICU, the duration of stay of a child in the hospital, extubation time, initiation of enteral feeding, recovery rate of enteral feeding volume. The data were statistically performed using the Mann-Whitney test to determine the significance of differences between the mean values (p0.05).Results. The study results demonstrated that the shortest duration of operational intervention was observed in patients of group 3, it constituted 41,4 3,5 minutes. In addition, patients of this group spent the shortest average time in the ICU - 4,2 0,3 days - and in the hospital in general - 12,1 0,8 days; initiation of enteral feeding in patients of this group was registered in 10,8 1,2 hours and the recovery rate of enteral feeding volume was 4,8 0,5 days.Conclusions. Having analyzed clinical outcomes for treatment of pilorostenosis in the studied groups of children, it is possible to conclude that laparoscopic pyloromyotomy is preferred to open surgical interventions not only for reasons of cosmetic result, but also according to the criteria of the postoperative course of the disease in patients.

Uncommon Causes of Pyloric and Duodenal Obstruction in Pediatric Population: Radiological and Surgical Correlation

Abstract Background: Duodenal and pyloric obstruction in neonates and young children have diverse causes such as atresia, volvulus, and foreign body or may be extra-luminal obstruction. Aim of Study: To assess causes of pyloric and duodenal obstruction in pediatric population (other than CHPS) and determine the causes of obstruction radiologically and compare them with surgical data. Patients and Methods: Our study included 22 patients (12 boys and 10 girls), age range from 1 day to 6 years. This study was done on cases of pyloric and duodenal obstruction in newborns, infants and young children less than 6 years in the period from 2017 through 2019. Cases of Congenital Hypertrophic Pyloric Stenosis (CHPS) were excluded from the study. The clinical, radiological data were gathered and compared to each other. Results: The spectrum of causes of pyloric and duodenal obstruction was as follow: 4 cases of pyloric atresia, 5 cases with duodenal atresia, 3 cases with duodenal stenosis by incomplete web, one case with annular pancreas, 4 cases with midgut volvulus, one case with duodenal duplication cyst, 3 cases with foreign body obstruction and one case with trichob-ezoar. All cases were treated surgically to alleviate the ob-struction. The radiological data were well correlated with surgical findings. Conclusion: Pyloric and duodenal obstruction in pediatric population has different causes. Radiological imaging could determine the cause of obstruction with good correlation with surgery.

Single-Site Umbilical Laparoscopic Pyloromyotomy Using a Pyloric Electrocoagulation Chisel Combined with a Left-Handed Main Operation for Congenital Hypertrophic Pyloric Stenosis.

Background: Laparoscopic pyloromyotomy has become a gold standard for the treatment of congenital hypertrophic pyloric stenosis (HPS). There have been recent reports on the use of transumbilical single-site laparoscopic surgery for congenital HPS; however, using transumbilical single-site laparoscopic surgery in pediatric cases is still controversial due to the difficulty with manipulation. In this study, some preliminary experience with the application of a novel transumbilical single-site laparoscopic approach in congenital HPS is described. Methods: A retrospective study was conducted involving 25 patients with congenital HPS treated in our hospital from August 2016 to August 2019. A pyloric electrocoagulation chisel combined with a left-handed main operation was completed in all of the patients and the operative times, postoperative length of stay, and operative complications were recorded. Results: The laparoscopic operation was completed in 25 patients with an average operative time of 21.9 ± 5.5 minutes, average postoperative length of stay of 2.5 ± 0.9 days, and no perforations of the pyloric mucosa, recurrent obstruction, surgical incision infections, and incision hernias. All of the patients had at least 3 months of follow-up, good growth and development, and the parents were satisfied with the postoperative scars. Conclusion: A pyloric electrocoagulation chisel combined with a left-handed main operation in the treatment of congenital HPS by a single-site umbilical laparoscopic pyloromyotomy is safe and effective, and can achieve a satisfactory cosmetic effect.

The Safety and Effectiveness of Laparoscopic versus Open Surgery for Congenital Hypertrophic Pyloric Stenosis in Infants.

BackgroundThis study aimed to investigate the safety and effectiveness of laparoscopic pyloromyotomy for infants with congenital hypertrophic pyloric stenosis.Material/MethodsThe clinical data of 233 infants with congenital hypertrophic pyloric stenosis who were treated at our hospital from January 2013 to January 2018 were analyzed retrospectively. The patients were divided into 2 groups: the laparoscopic group (group A, n=126) and the conventional operation group (group B, n=107).ResultsLaparoscopic surgery was successfully performed in all patients in the laparoscopic group, and none of the surgeries were converted to open surgery. Compared with traditional surgery, laparoscopic surgery has obvious advantages in operation time (29.8±12.9 minutes versus 37.2±17.5 minutes, P=0.012), postoperative feeding time (10.3±2.2 hours versus 15.2±4.1 hours, P=0.035), postoperative hospitalization time (2.8±0.7 days versus 3.5±1.9 days, P=0.013), incision length (0.9±0.2 cm versus 3.3±0.8 cm, P=0.002) and poor wound healing (0 versus 6, P=0.007). No complications, such as bleeding, gastric perforation, duodenal injury, abdominal infection or recurrent vomiting, were observed in the 2 groups. The growth and development (weight and height) of the infants in both groups were normal.ConclusionsLaparoscopic pyloromyotomy has the same safety and effectiveness as the traditional operation and has the advantages of less trauma, faster recovery and cosmetically pleasing incisions.

СОЧЕТАНИЕ СИНДРОМА ЛЕДДА C ВРОЖДЕННЫМ ГИПЕРТРОФИЧЕСКИМ ПИЛОРОСТЕНОЗОМ

Background. The combination of the two congenital pathological conditions – compression of the duodenum by embryonic cords of the peritoneum and congenital inversion of the small intestine and right half of the colon due to incomplete bowel rotation – was described in detail by W. E. Ladd in 1932, thus the pathology is known as “Ladd’s syndrome” (LS). Congenital pyloric stenosis belongs to a group of severe birth defects. The disease is based on a congenital violation of the morphological structures of the pyloric sphincter of the stomach due to hypertrophy of the circular muscle layer and interstitial tissue leading to pyloric stenosis and impaired patency in this part of the gastrointestinal tract. Objective. Demonstration of diagnostics and treatment peculiarities of a rare case of a combined pathology of the gastrointestinal tract in a newborn. Material and methods. The data from clinical observation of the patient M., 3 days old, who was treated in the neonatal Department of the Grodno regional children’s clinical hospital (GODKB) since December 2018 till March 2019. Results. The child was found to have a combination of Ladd’s syndrome with congenital hypertrophic pyloric stenosis. Successful correction of the birth defects was performed. Conclusion. We have presented a case report that hasn’t been yet described in literature. Despite the diffculties in diagnostics, the patient was discharged with recovery. The follow-up examination in 2020 revealed no abnormalities in the child’s development.

Correlation between pyloric muscle thickness and changes of acid-base status in children with congenital hypertrophic pyloric stenosis

Correlation between pyloric muscle thickness and changes of acid-base status in children with congenital hypertrophic pyloric stenosis

Study of incidence and outcome of structural malformed foetus in delivered patients

Introduction: Congenital fetal anomalies are one of the most threatening complications which are prevalent in the society associated with severe morbidity and mortality in the newborn foetus. Congenital anomalies account for 8% to 15% of perinatal deaths and 13% to 16% of neonatal deaths in India. The etiology of congenital abnormality may be genetic or environmental. Aim and Objective: The present study was carried out with the aim to determine the overall incidence and outcome of congenital structural malformations in delivered patients, to identify the most common structural anomaly and study the socio-demographic correlates with structural anomalies and compared them to previous studies. Materials and Methods: The study was conducted on all obstetrics patients with concent who have delivered with fetal congenital malformations in Medical College Pune, Maharashtra over a period of 2 year satisfying inclusion and exclusion criteria. The questionnaire was prepared included the information regarding mothers age, gender birthweight, religion and socioeconomic, past and personal history was included. Data management and analysis was done using Epi-info software. The frequency distribution and graph was prepared. The categorical variables was assessed using Pearson chi-square. Results: It was observed that the overall incidence of structural malformed foetus delivered came out to be 1.2%. Low Birth weight, Low socio economic status and female gender of child are commonly involved in congenital structural malformations. There was no significant association observed between system involved with gender of child, gestational age or history of abortion. The most common anomaly found is related to GIT followed by the Genitourinary. Conclusion: We conclude that gastrointestinal, genitor-urinary, cardiovascular and nervous systems are commonly involved in congenital structural malformations. Among the gastro-intestinal system congenital hypertrophic pyloric stenosis and An

Congenital Hypertrophic Pyloric Stenosis: A Case at the Gunung Wenang Hospital Manado - North Sulawesi Indonesia

On a baby girl of 4 weeks old with the dtagnosts of congenital hypertrophic pyloric stenosis, an extremely rare case in our Hospital, surgical operation was done using the Fredet Ramsted method.&#x0D; The main complaint was frequent vomiting. The diagnosis was based on projectile vomiting, retarded growth, constipation, moderate dehydration and was confirmed by barium meal study.&#x0D; Ten days after the operation, she was discharged in a good condition.

Effects of Hospital Volume on Patient Outcomes and Costs in Infants With Pyloric Stenosis

BackgroundThere is a well-established relationship between surgical volume and outcomes after complex pediatric operations. However, this relationship remains unclear for common pediatric procedures. The aim of our study was to investigate the effect of hospital volume on outcomes after hypertrophic pyloric stenosis (HPS). MethodsThe Kid's Inpatient Database (2003-2012) was queried for patients with congenital HPS, who underwent pyloromyotomy. Hospitals were stratified based on case volume. Low-volume hospitals performed the lowest quartile of pyloromyotomies per year and high-volume hospitals managed the highest quartile. Outcomes included complications, mortality, length of stay (LOS), and cost. ResultsOverall, 2137 hospitals performed 51,792 pyloromyotomies. The majority were low-volume hospitals (n = 1806). High-volume hospitals comprised mostly children's hospitals (68%) and teaching hospitals (96.1%). The overall mortality rate was 0.1% and median LOS was 2 d. High-volume hospitals had lower overall complications (1.8% versus 2.5%, P < 0.01) and fewer patients with prolonged LOS (17.0% versus 23.5%, P < 0.01) but had similar rates of individual complications, similar mortality, and equivalent median LOS as low-volume hospitals. High-volume hospitals also had higher costs by $1132 per patient ($5494 versus $4362, P < 0.01). Regional variations in outcomes and costs exist with higher complication rates in the West and lower costs in the South. There was no association between mortality or LOS with hospital volume or region. ConclusionsPatients with pyloric stenosis treated at high-volume hospitals had no clinically significant difference in outcomes despite having higher costs. Although high-volume hospitals offer improved outcomes after complex pediatric surgeries, they may not provide a significant advantage over low-volume hospitals in managing common pediatric procedures, such as pyloromyotomy for congenital HPS.

Etiologies and In-Hospital Outcomes of Nonhemolytic Jaundice among Infants at King Abdulaziz University Hospital (KAUH)

Background: most of articles addressed the underlying causes and management of Neonatal Nonhemolytic Jaundice, however only a few have investigated nonhemolytic jaundice among infancy which can turn fatal in severe case, however can be prevented by early diagnosis. Aim of the Work: was to investigate the most common etiologies of nonhemolytic jaundice among infants presented to at King Abdulaziz University Hospital (KAUH) which may help pediatricians to rearrange their differential diagnosis about nonhemolytic jaundice in infants. Material and Methods: this is a retrospective observational study of all infants aged between 1-12 months, conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia from January 2016 to November 2017. Data collection was done using Microsoft Excel while data analysis was done using SPSS version 21. Chi -square test was used to test if associations would be appropriate. Results: out of total 105 patients enrolled in this study, complete data set was available for 88 only patients during 2012. The mean age at presentation in months was 2.73 (± SD 2.21) range from 1 to 12 months. Among the sample, the final outcome was as follows ; 59 (67%) jaundice-free, 14 (15.9%) still diseased and 15 (17%) dead. Sepsis was the most common cause of jaundice with 33 cases (37.5%), followed by biliary atresia 10 cases (11.4%) and congenital hypertrophic pyloric stenosis 7 cases (8%). On the other hand, the least common causes were rare diseases like wolman syndrome, crigler-najjar syndrome and autoimmune hepatitis and each of them represents 1 case. The overall number of deaths in our study was 15 (17%). Seven of them were due to sepsis and 2 were due to biliary atresia. Conclusion: we hope to help the local physicians in Jeddah to arrange their differential diagnosis of nonhemolytic jaundice among infants and deal with it seriously, due to the high incidence of critical illness and death.

Etiologies and In-Hospital Outcomes of Nonhemolytic Jaundice among Infants at King Abdulaziz University Hospital (KAUH)

Background: most of articles addressed the underlying causes and management of Neonatal Nonhemolytic Jaundice, however only a few have investigated nonhemolytic jaundice among infancy which can turn fatal in severe case, however can be prevented by early diagnosis. Aim of the Work: was to investigate the most common etiologies of nonhemolytic jaundice among infants presented to at King Abdulaziz University Hospital (KAUH) which may help pediatricians to rearrange their differential diagnosis about nonhemolytic jaundice in infants. Material and Methods: this is a retrospective observational study of all infants aged between 1-12 months, conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia from January 2016 to November 2017. Data collection was done using Microsoft Excel while data analysis was done using SPSS version 21. Chi -square test was used to test if associations would be appropriate. Results: out of total 105 patients enrolled in this study, complete data set was available for 88 only patients during 2012. The mean age at presentation in months was 2.73 (± SD 2.21) range from 1 to 12 months. Among the sample, the final outcome was as follows ; 59 (67%) jaundice-free, 14 (15.9%) still diseased and 15 (17%) dead. Sepsis was the most common cause of jaundice with 33 cases (37.5%), followed by biliary atresia 10 cases (11.4%) and congenital hypertrophic pyloric stenosis 7 cases (8%). On the other hand, the least common causes were rare diseases like wolman syndrome, crigler-najjar syndrome and autoimmune hepatitis and each of them represents 1 case. The overall number of deaths in our study was 15 (17%). Seven of them were due to sepsis and 2 were due to biliary atresia. Conclusion: we hope to help the local physicians in Jeddah to arrange their differential diagnosis of nonhemolytic jaundice among infants and deal with it seriously, due to the high incidence of critical illness and death.

Congenital Hypertrophic Pyloric Stenosis At A Tertiary Care Hospital: A Surgical Experience With 30 Infants

Congenital Hypertrophic Pyloric Stenosis At A Tertiary Care Hospital: A Surgical Experience With 30 Infants