Outlet Obstruction In Infants Research Articles

Ultrasonographic Evaluation in Early Diagnosis of Infantile Hypertrophic Pyloric Stenosis

Background: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants. This study was conducted to identify the accuracy of ultrasonography in the diagnosis of infantile Hypertrophic pyloric Stenosis.
 Methods: This cross-sectional descriptive. Study was conducted in Department of radiology and imaging, institute of child and mother health during two year period from 16th September 2016 to 16th September 2018. Fifty patients <8 weeks of age who presented with complaints of non-bilious vomiting were included in the study. Abdominal ultrasound was performed in all the cases. On ultrasonography pyloric canal length, diameter and pyloric muscle wall thickness was measured. Open surgery was performed as per indications and after informed consent. The pre-operative findings were compared with ultrasongraphic findings. Study variable were male to female ratio, percentage of cases in which pyloric mass was palpable. We also compare the duration of onset of symptoms with pyloric canal length, diameter and muscle thickness.
 Results: In this study, out of 50 patients, 46 (92%) were male and 4 (8%) were females. Gastric peristalsis was visible in 100% patients and mass was palpable in 14 (28%) patients. Pyloric canal length was more than standard in 98% cases; canal diameter was more than the standard in 87% cases and pyloric muscle thickness in 60% of cases. Ultrasonographic findings remained 98% accurate in this study.
 Conclusion: Ultrasonography is an investigation of choice for early diagnosis of IHPS before significant fluid and electrolyte imbalance occur. It is cost effective, harmless, freely available and easier to perform.
 J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 208-211

Survival and Kidney Outcomes of Children with an Early Diagnosis of Posterior Urethral Valves.

Posterior urethral valve is the most common cause of bladder outlet obstruction in infants. We aimed to describe the rate and timing of kidney-related and survival outcomes for children diagnosed with posterior urethral valves in United States children's hospitals using the Pediatric Health Information System database. This retrospective cohort study included children hospitalized between January 1, 1992 and December 31, 2006, who were in their first year of life, had a diagnosis of congenital urethral stenosis, and underwent endoscopic valve ablation or urinary drainage intervention, or died. Records were searched up to December 31, 2018 for kidney-related mortality, placement of a dialysis catheter, and kidney transplantation. Cox regression analysis was used to identify risk factors, and Kaplan-Meier survival analysis used to determine time-to-event probability. Subgroup survival analysis was performed with outcomes stratified by the strongest identified risk factor. Included were 685 children hospitalized at a median age of 7 (interquartile range, 1-37) days. Thirty four children (5%) died, over half during their initial hospitalization. Pulmonary hypoplasia was the strongest risk factor for death (hazard ratio, 7.5; 95% confidence interval [95% CI], 3.3 to 17.0). Ten-year survival probability was 94%. Fifty-nine children (9%) underwent one or more dialysis catheter placements. Children with kidney dysplasia had over four-fold risk of dialysis catheter placement (hazard ratio, 4.6; 95% CI, 2.6 to 8.1). Thirty-six (7%) children underwent kidney transplant at a median age of 3 (interquartile range, 2-8) years. Kidney dysplasia had a nine-fold higher risk of kidney transplant (hazard ratio, 9.5; 95% CI, 4.1 to 22.2). Patients in this multicenter cohort with posterior urethral valves had a 5% risk of death, and were most likely to die during their initial hospitalization. Risk of death was higher with a diagnosis of pulmonary hypoplasia. Kidney dysplasia was associated with a higher risk of need for dialysis/transplant. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_10_03_CJN04350419.mp3.

Infantile hypertrophic pyloric stenosis and bilious vomiting: An unusual presentation

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants, presenting with nonbilious projectile vomiting. The authors report a rare case of bilious vomiting in a neonate with intraoperatively diagnosed IHPS and no other gastrointestinal anomalies.

The Delayed Diagnoses of Hypertrophic Pyloric Stenosis due to Hospitalization in Neonatal Intensive Care Unit: A Report of 5 Cases

Hypertrophic pyloric stenosis (HPS) is the most common cause of gastric outlet obstruction in infants. It commonly requires surgery. Its incidence is 0.17-4.4 cases per 1,000 live births. The clinical findings of pyloric stenosis typically appear within three to five weeks after birth. Its most important clinical finding is non-bilious projectile vomiting. If its diagnosis is missed in early period, the most common finding is dehydration (with hypochloremic hypokalemic metabolic alkalosis). However the findings of HPS might be frequently masked in infants hospitalized for longer periods in neonatal intensive care unit. Because vomiting is the one of most common symptoms, it may be related to the different etiological factors of vomiting (congenital or genetic causes, NEC, sepsis, nutritional intolerance), blockage of projectile vomiting with gastric drainage by previously inserted indwelling orogastric/nasogastric catheter which prevents development of excessive gastric dilatation. The accurate diagnosis delays with elimination of severe alkalosis and electrolyte disorder and prevention of malnutrition with administered parenteral nutrition. Herein we would like to draw attention the delayed diagnosis of HPS in five neonatal cases who were hospitalized in the neonatal intensive care unit (nicu) for longer periods.

Infantile hypertrophic pyloric stenosis at a tertiary care hospital in Tanzania: a surgical experience with 102 patients over a 5-year period.

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.

Presentation And Outcome Of Infantile Hypertrophic Pyloric Stenosis: A Five Year Retrospective Study In Chittagong Medical College

Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants with a prevalence of 1.5 to 4.0 per 1000 live births. It has been suggested that the incidence is increasing. USG is the most useful method for diagnosis supplanting physical examination and pyloromyotomy is the time honored treatment option. A retrospective review of the patients of IHPS admitted in the department of Pediatric Surgery, Chittagong Medical College Hospital (CMCH) Chittagong, Bangladesh from January 2008 to December 2012 was done. Help was also taken from yearly departmental audits of 2008 to 2012. Data were analyzed with regard to occurrence, seasonal variation, gender variation, presentation, diagnosis, treatment and outcome. Statistical analysis was performed by the chi-square test, and mean and percentage values were calculated. P&lt;0.05 was considered to be statistically significant. There were 42 patients of IHPS. Age range was 5 days to 1 year 8 months with mean age of 79 days. Male to Female ratio was 2.5:1. There was no significant difference between the rate of occurrence of IHPS and gender (P=0.5). There were 2 peaks on seasonal variations of IHPS during summer and winter but quarterly distribution was not statistically significant. Nonbilious vomiting was the most common clinical presentation and USG was the most useful investigation. Pyloromyotomy was done in all patients and persistent vomiting (24%) was the most common complication. The occurrence of IHPS was 0.29% of all admissions. There was no significant gender or seasonal variations. USG has replaced clinical examination as the most effective tool for diagnosis. Ramstedt pyloromytomy is still the choice of treatment on the basis of outcome.&#x0D; JCMCTA 2013 ; 24 (2): 9-13

Congenital bladder diverticulum presenting as bladder outlet obstruction in infants and children

PurposeCongenital primary bladder diverticulum is a rare cause of infra-vesical obstruction. We present a series of 12 cases who presented with urinary retention secondary to a large primary bladder diverticulum. The aim is to high light the diagnostic difficulties and management issues of congenital bladder diverticulae. MethodsWe reviewed the case sheets of 12 patients with congenital bladder diverticulae who presented as lower tract obstruction with or without infection at a tertiary care centre in the last 10 years. All patients had urine examinations (complete microscopic with culture), serum creatinine, ultrasonography, intravenous urogram, voiding cystourethrogram with or without cystoscopy. The cases were managed by extravesical mobilization of diverticulae, diverticulectomy, and ureteric re-implantation. All patients (aged 1–36 months, mean 16.8 months) presented with retention of urine but 4 of them had symptoms of fever, tachycardia, abdominal distension and vomiting. Serum creatinine was normal in 10 out of 12 cases, but was high in two. Urine cultures grew Escherichia coli in 5 cases. Ultrasonography showed moderate to severe hydronephrosis on the left side in 5 cases, on the right side in 4 cases and bilateral in 3 cases but diverticulae could be located in only 8 cases. Intravenous urogram revealed hydrouretero-nephrosis in 9 cases, a poor functioning kidney with hydrouretero-nephrosis in 3 cases and bilateral hydrouretero-nephrosis in 3 cases. A Voiding Cystourethrogram confirmed the diagnosis in all cases. Vesicoureteric reflux (Grade 4–5) into the ipsilateral ureter was seen in 9 children of which it was bilateral in three cases. ResultsAll children underwent extravesical diverticulectomy with re-implantation of the ipsilateral ureter in 9 cases, bilateral in 3 cases. All had an uneventful recovery except for one who had a suprapubic leak which healed on conservative treatment. Postoperative ultrasonograms showed mild hydronephrosis in 2 cases and micturating cystourethrograms revealed a grade III V-U reflux in one case which was managed conservatively. Patients are maintaining a sterile urine culture after a follow up of 6–36 months. ConclusionPrimary bladder diverticulum should be kept as a differential diagnosis in cases of bladder outlet obstruction in infants and children. A carefully done voiding cystourethrogram is the hallmark of diagnosis. Good results can be achieved by diverticulectomy and primary definitive repair with ureteric re-implantation even in infants.

Gastric antrum hypertrophy causing outlet obstruction in an infant with congenital diaphragmatic hernia

Congenital diaphragmatic hernia (CDH) is associated with multiple congenital anomalies affecting several organ systems, including the gastrointestinal system. Pyloric stenosis and bands are known and previously reported etiologies of gastric outlet obstruction in infants with CDH. We report the first case of gastric antrum hypertrophy causing gastric outlet obstruction in an infant with CDH.

Delayed presentation of hypertrophic pyloric stenosis: a rare case

Hypertrophic pyloric stenosis (HPS) is the most common cause of gastric outlet obstruction in infants, with an incidence of 1.5 to 3 per 1000 live births, and classically presents at 3 to 4 weeks of age. Delayed presentation of HPS is an extremely rare occurrence after early infancy. With the exclusion of congenital HPS, gastric outlet obstruction in childhood is a rare condition (1:100,000). We report a case of delayed presentation of HPS in a 4 1/2–year-old child in whom the pylorus was hypertrophied and appeared like an “olive,” and for which pyloromyotomy was curative.

Congenital Antral Membrane: Case Report

Congenital Antral Membrane: Case Report

Radiologic features of gastric outlet obstruction in infants after long-term prostaglandin administration.

Long-term prostaglandin (PG) therapy has recently been associated with gastric mucosal hyperplasia. We reviewed the clinical and radiologic (especially sonographic) records of eight patients with complex congenital heart disease who were on PG therapy. Feeding problems, vomiting, and abdominal distension were present in six patients. Barium meal revealed antral narrowing in three patients, suggestive of hypertrophic pyloric stenosis in two. Sonography showed a variable degree of increased gastric mucosal lobulation often accompanied by a marked polypoid or lobular appearance. Cortical hyperostosis related to PG therapy was seen in three patients. PG-associated gastric mucosal hyperplasia can cause feeding problems and pronounced gastric lobulation.

Halitosis and gastric outlet obstruction in infants

International Journal of Clinical PracticeVolume 44, Issue 10 p. 419-419 Case Reports Halitosis and gastric outlet obstruction in infants B A Madarikan FRCS, Corresponding Author B A Madarikan FRCS n/[email protected] Department of Surgery, University Hospital of Wales, Heath Park, CardiffAddress correspondence to Mr B A Madurikan. Department of Surgery, University College Hospital. Ibadan. Nigeria.Search for more papers by this authorB I Rees FRCS, B I Rees FRCS Department of Surgery, University Hospital of Wales, Heath Park, CardiffSearch for more papers by this author B A Madarikan FRCS, Corresponding Author B A Madarikan FRCS n/[email protected] Department of Surgery, University Hospital of Wales, Heath Park, CardiffAddress correspondence to Mr B A Madurikan. Department of Surgery, University College Hospital. Ibadan. Nigeria.Search for more papers by this authorB I Rees FRCS, B I Rees FRCS Department of Surgery, University Hospital of Wales, Heath Park, CardiffSearch for more papers by this author First published: 01 October 1990 https://doi.org/10.1111/j.1742-1241.1990.tb10881.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume44, Issue10October 1990Pages 419-419 RelatedInformation

Prepyloric gastric antral web: A puzzling epidemic

Antral webs and diaphragms are considered a rare cause of gastric outlet obstruction in infants and children. A radiographic diagnosis of antral web was made in 28 children during a 26-mo period. Nonbilious, often projectile vomiting was the predominant presenting symptom in 24 infants who were less than 6 mo of age. The older children complained of pain, vomiting, fullness after eating, and eructation. The characteristic radiologic finging was a wirelike transverse septum 1--2 cm proximal to the pylorus. Poor antral filling was an important early clue in the radiographic search for the webs. Pyloroplasty was performed in 20 patients, frequently after failure of medical management of symptoms. Coexistent congenital abnormalities were present in 28% of patients. A search for environmental and familial factors has failed to elucidate any teratogenic influences in this population.

Antral diaphragm—a cause of gastric outlet obstruction in infants and children

Gastric outlet obstruction in infants and children may be due to a partial, prepyloric antral diaphragm. Twelve new patients are added to the 32 described previously. Onset of symptoms varied from shortly after birth to five years. Nonbilious vomiting was the most common presenting symptom. Radiographic evaluation requires specific technique for demonstration of the web and to differentiate this from pylorospasm and pyloric stenosis. Gastroscopy was employed in three patients. Repair usually consisted of incision of the web and construction of a patulous gastric outlet. All patients remained asymptomatic after operation. The etiology of the webs remains unknown, but they may result from an excessive local endodermal proliferation early in gastric development.

Pyloric Atresia- A Case Report

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infant. The prevalence of IHPS ranges from 1.5 to 4.0 in 1000 live birth. But the incidence of IHPS has been increasing approximately from 1.5 to 4.0 in 1000 live birth to 1:150. Though pyloric atresia is a very uncommon cause of gastric outlet obstruction in infant but atresia in this region occurs in the form of web, membrane/diaphragm or rarely solid cord. Membrane/ diaphragm may be single or double and may be perforated or imperforated. If the size of perforation is less than 10 mm, it causes complete obstruction. We report the presentation and management of such a child. DOI: 10.3329/bjch.v33i1.5674Bangladesh Journal of Child Health 2009; Vol.33(1): 35-36

Infantile Hypertrophic Pyloric Stenosis - Experiences of 77 Cases

Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants which needs surgical treatment. The aim of this study was to review the management of IHPS in our hospital to compare with other developed centers. This is a prospective analytical study carried out in the Department of Pediatric Surgery, Faridpur Medical College Hospital and Dr. Zahed Children Hospital at Faridpur, during the period of May 2002 to October 2010. Total 77 patients were treated by Ramstedt's pyloromyotomy after proper diagnosis and resuscitation. The male to female ratio was 10:1. Most of the patients presented to us within 40 days of age (90%).Younger one was 15 days and elder one was 69 days. In all cases diagnosis were done on clinical basis. The diagnosis is confirmed by barium meal x-ray in 71 cases and sonogram in 15 cases. Serum electrolytes were not estimated in all patients. There was moderate to severe dehydration in more than 60% cases. 71 cases were operated under general anesthesia and 06 cases were operated with local anesthesia. There was one postoperative death on 4th post-operative day. Oral feeding started after 8 to 10 hours postoperatively in all cases. Mucosal perforation occurred in 1 case and that was recognized and treated conservatively without any ill effect. Superficial wound infection encountered in 3 cases. Early diagnosis, preoperative correction of dehydration and electrolyte imbalance and experiences of surgeons play important role for management of IHPS. Key words: IHPS; Pyloromyotomy; Dehydration; Local anesthesia; Mucosal perforation. DOI: 10.3329/fmcj.v6i1.7401 Faridpur Med. Coll. J. 2011;6(1): 02-04