INFANTILE HYPERTROPHIC PYLORIC Stenosis

1. Yvonne N. N
INFANTILE HYPERTROPHIC PYLORIC STENOSIS
Epidemiology
common between 2-6wks of age and rarely occurs after 12 weeks of age
common in whites, rare in blacks and Asians
R/Fs - male sex
Preterm <30wks
Young maternal age < 20yrs 1.3 risk
Maternal hx of HPS – esp when occurs below 2wks of age and use of macrolides within 1st
2
weeks or hx of macrolides use in mother during 3rd
trimester
First borns
c/s delivery
bottle feeding
Associations
Trisomy 18- Edward
Traceo-esophageal fistula
c/fs
non billous post prandial vomiting , olive like mass on P, can feel the wavelike sensation and succussion
splash on ausc- – relevant when hours after feed
INVEST
Abd xray of little significance – distal bowel loops with gas
Abd u/s – 97% specificity, 100% sensitivity, string sign, tit sign, beak sign, etc
Fluoroscopy
Barium meal helps exclude midgut volvulus but exposes to ionizing radiation
CAUTION
Electrolyte imbalance – tend to get hypochlraemic met alkalosis d/t vomiting
>3wks of vomiting – onset of hypokalemia
Can operate
Length >15-17 + gd electrolytes
Rarely recur

2. Yvonne N. N
References – uptodate + radiopedia