= Abstract =
. Clinical Analysis of Infantile Hypertrophic Pyloric Stenosis
Young Soo Huh, M.D., Myeung Kook Lim, M.D., Kyu Rak Kim, M.D.
Department of Pediatric Surgery, College of Medicine, Yeungnam University Taegu, Korea
Infantile hypertrophic pyloric stensosis(IHPS) occurs in three of 1000 live births, and is a major cause of nonbilious vomiting of early infancy. It's etiology and pathogenesis however are still obscure. The operation of pyloromyotomy de- scribed by Ramstedt in 1912 remains the standard treatment. From January 1990 to July 1997, 64 infants with IHPS were treated at the Department of Pediatric Sursery, Yeungnam University Hospital. The ratio of male to female was 7:1, and the most prevalent age ranged from 2 weeks to 8 weeks(81.2 %) of age.
Fifty-seven infants were first born (57.8 percent). The body weight of all pa- tients at admission was below the 50 percentile. Age of onset of symptoms was between 2 and 4weeks of age in 23 cases(35.9 %). All infants had a history of nonbilious vomting, generally projectile in nature. Hypokalemia was noted in 14 cases(21.9 %) and hypochloremia in 26 cases( 40.6 %). In the preoperative ultra- sonography, the average muscle thickness, diameter, and length of the pylorus were 6.3 mm, 12.3 mm, and 17.8 mm. A total of 13 associated anomalies were noted in 12 patients. All cases were treated with Fredet-Ramstedt pyloromyotomy.
Postoperative wound infection occured in 3 cases. Thirteen cases(20.3 %) pre- sented intermittent nonprojectile vomiting after operation. With control of oral intake vomiting subsided within one week in 63 patients, and in thirteen days in another.
Index Words: Hypertrophic pylorc stenosis, Infantile
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Table 1. Age and Sex Distribution
Age(wk) Male Female Total
(1 1 1 2
1-(2 3 0 3
2-(4 15 2 17
4-(6 18 3 21
6-(8 12 2 14
)8 7 0 7
Total 56 8 64
Table 2. Gestational Age
Gestational age No. of cases %
Full term 61 95.3
Prematurity 3 4.7
Total 64 100.0
Table 3. Birth Weight
Birth weight(kg) No. of cases %
(2.5 5 7.8
2.5-(3.0 9 14.0
3.0-(3.5 36 56.3
)3.5 14 21.9
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Table 4. Incidence Related to Feeding Percentile No. of cases %
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3-(10 2 3.1
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)50 0
Total 64 100.0
Table 5. Body Weight Percentile at Admission Symptoms and
No. of cases % physical findings
Projectile vomiting 64 100.0
Peristaltic wave 16 25.0
Palpable mass 19 29.7
Weight loss 17 26.6
Constipation 6 9.4
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Table 6. Pyloric Dimensions by Ultrasonography Dimensions (mm) No. of cases
(4 13
Thickness 4-(6 30
::::6 17
(10 1
Diameter 10-(15 38
15-(20 19
::::20 2
(10 0
Length 10- (15 12
15-(20 37
::::20 11
Table 7. Associated Anomalies Anomalies
Inguinal hernia Torticollis
Ventricular septal defect Tongue tie
Malrotation
Gastroesophageal reflux Cryptochidism
Total
No. of cases 3 1 2 2 1 3 1 13
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