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Hypertrophic Pyloric Stenosis
History
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The history of what we now refer to as infantile
hypertrophic pyloric stenosis dates back to the
early 1700s.
Blair described an infant with postmortem
findings consistent with hypertrophic pyloric
stenosis in 1717.
Epidemiology
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Infantile hypertrophic pyloric stenosis (IHPS) is the most common
cause of gastric outlet obstruction in infants.
The prevalence of IHPS ranges from 1.5 to 4.0 per 1000 live births
in Caucasian infants but is less prevalent in African-American and
Asian children.
Reports have suggested that the incidence is increasing.
It is well known that it is more common in boys than girls, with a
ratio of approximately 2:1 to 5:1.
The occurrence of IHPS has been associated with several variables
including both environmental and familial factors.
IHPS is now thought to be caused by a mechanism other than a
developmental defect.
Anatomy
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The gross appearance of the pylorus in
IHPS is that of an enlarged,pale muscle
mass usually measuring 2 to 2.5 cm in
length and 1 to 1.5 cm in diameter.
Etiology
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The etiology of IHPS has eluded investigators for several
decades and no definitive causative factors have been
identified.
Both genetic and environmental factors seem to play a
role in the pathophysiology.
Another focus has been on alterations in relaxation of
the pyloric muscle.
As new technology and concepts have
evolved,additional associations that involve IHPS and
gastrointestinal peptides, growth factors, neurotrophins,
changes in neural development, and nitric oxide have
been described.
Diagnosis
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Nonbilious projectile vomiting.
Visible peristaltic waves in the left upper part of the
abdomen.
Diagnosis can be made in 75% of infants with IHPS by
careful physical examination of the upper part of the
abdomen.you can palpate an enlarged pylorus.
US(ultrasound) has become not only the most common
initial imaging technique for the diagnosis of IHPS but
also the standard for diagnosing IHPS.
Hypochloremic、Hypokalemic、Metabolic alkalosis.
Treatment
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Minimal Laparotomy (“Open”) Technique
Treatment
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Laparoscopic Procedure
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Treatment
(postoperative management )
In the majority of infants, feeding can be
started within 4 hours after the surgical
procedure.
 Infants with hematemesis from gastritis
may benefit by delaying feeding for an
additional 6 to 12 hours after the
procedure.
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Postpyloromyotomy Feeding Schedule
For very small infants, the starting feeding volume may be reduced to 15 mL and the schedule stopped at volumes of 60 to
75 mL, which provide an adequate calorie supply.
Complications
Complications after pyloromyotomy should
be minimal if performed by experienced
surgeons.
 Perforation (In a large series of infants
undergoing open pyloromyotomy, the
incidence of perforation was 2.3%).
 Wound-related complications occurred in
1%.
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