This document provides information about infantile hypertrophic pyloric stenosis (IHPS). It describes IHPS as a condition causing intestinal obstruction in infants due to hypertrophy and hyperplasia of the pylorus muscle layers. It presents epidemiological data and common symptoms such as projectile vomiting. Examination may reveal an olive-sized hard mass in the epigastrium. Investigations include ultrasound revealing thickened pyloric muscle over 13mm. Treatment involves pre-operative correction of dehydration and alkalosis followed by Ramstedt's pyloromyotomy to cut the hypertrophied muscle longitudinally. Risks and consent information for the procedure are also outlined.

1. LT COL SM SHAHADAT HOSSAIN
MCPS,FCPS(surgery)FCPS(Thoracic
surgery)
Adv Trg on Thoracoscopy CNUH, South
Korea
INFANTILE HYPERTROPHIC PYLORIC
STENOSIS (IHPS)

2. IHPS
 Most common cause of intestinal obstruction in
infancy.
 It is due to hypertrophy and hyperplasia of the
muscular layers of the pylorus.

3. Epidemiology
 Age: 2 and 8 weeks and rarely13 weeks.
 Incidence: 1:300.
 Male: female:4:1.
 Genetic predisposition.

4. Symptoms
 Non-bilious projectile vomiting.
 Test feeding; visible gastric peristalsis is seen in
the upper abdomen.

5. On Examination
 Firm, non-tender, and mobile hard mass 1-2 cm
as an "olive,“ in the epigastrium.
 Dehydration.
 Malnutrition.

6. Investigations
 CBC, blood grouping.
 Electrolytes – Hypochloremia, hypokalemia,
hyponatremia.
 Urea, creatinine.

7. Investigations
Ultrasound of abdomen:
 Thickened pyloric muscle; 3cm or more and
length of pylorus greater than 13mm.

8. TREATMENT
Pre-operative preparation:
 NPO.
 Nasogastric suction; 8–10 Fr.
 Correction of dehydration and alkalosis is
corrected by giving 150–180 mL/kg/day of 0.9%
saline with 0.15% KCl in 5% glucose.

9. Ramstedt’s pyloromyotomy
 By a laparoscopic or open supraumbilical
incision under GA.
STEPS:
 Longitudinal incision is made in the pylorus.
 Hypertrophied muscle is cut along the whole
length until the mucosa bulges out.
 If the mucosa is injured, it is sutured horizontally
using interrupted vicryl.

10. IMAGE

11. IMAGE

12. Post operative
 NPO for 24 hrs.
 Nasogastric suction.
 IV fluid150–180 mL/kg/day of 0.9% saline with
0.15% KCl in 5% glucose.
 Antibiotics.
 Analgesic.

13. COMPLICATIONS
 Peritonitis from perforation through the mucosa.
 Haemorrhage.
 Residual stenosis.
 Wound infection.
 Wound dehiscence.

14. CONSENT INFORMATION
PROCEDURE:
 A cut into an abnormal muscle mass at the end
of the stomach, to allow normal stomach
emptying.
ANAESTHETIC:
RISKS OF THIS PROCEDURE:

15. CONSENT INFORMATION
RISKS OF THIS PROCEDURE:
 Rarely when the muscle is divided, the
stomach lining may be holed
 Damage to the bowel, which may cause
leakage of bowel fluid.
 Deep bleeding in the abdomen.
 Infections such as pus collections in the
abdominal cavity.

16. CONSENT INFORMATION
RISKS OF THIS PROCEDURE:
 The bowel movement may be paralysed or
blocked after surgery.
 A weakness in the wound.
 The baby may continue to vomit for some days
after the operation.
 Rarely further surgery may be necessary to
divide more muscle.
 Adhesions may form and cause bowel
blockage.

17. CONSENT INFORMATION
PARENT CONSENT:
 I acknowledge that:
 The doctor has explained my child's medical
condition and the proposed procedure. I
understand the risks.

18. CONSENT INFORMATION
DOCTOR'S STATEMENT:
 I have explained to the parent: - the child's
condition - need for treatment - the procedure
and the risks - relevant treatment options and
their risks.
 Name of Doctor
 Designation
 Signature
 Date