Hypertrophic Pyloric Stenosis

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• Hypertrophic Pyloric Stenosis

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History

• 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.

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Epidemiology

• 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 21 to
  51.
• 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.

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Anatomy

• 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.

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Etiology

• 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.

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Diagnosis

• 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.

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Treatment

• Minimal Laparotomy (Open) Technique

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Treatment

• Laparoscopic Procedure
• 1 2
  3

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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.
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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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• Thank you