Learning objectives
To describe and illustrate the imaging characteristics of infantile hypertrophic stenosis of the pylorus,
giving practical dynamic tips not found in textbooks to ensure a rapid and correct diagnosis.
Based on our own clinical experience and an up-to-date review of the literature,
we describe and illustrate the anatomy of the antropyloroduodenal region,
the normal appearance of the pylorus on imaging studies,
the characteristics of hypertrophic stenosis,
how to perform the examination,
possible complications,
and posttreatment changes on imaging studies.
After viewing this educational exhibit,
radiologists...
Background
Definition and Etiology
Infantile hypertrophic pyloric stenosis,
the most common surgical condition producing emesis in infancy,
was first described by Hirschsprung in 1888.
The pyloric muscle is hypertrophied and the pyloric channel becomes narrow and elongated,
causing gastric outlet obstruction.
It typically develops between 2 and 8 weeks after birth.
The incidence is approximately 2 to 5 per 1000 live births.
It is more common in boys: the ratio of boys to girls affected is 4.8:1.
The cause is unknown,
although various genetic factors,
environmental...
Imaging findings OR Procedure details
Practical Analysis
Let’s play a game! Imagine…
On a day like any other day,
we are in the US examination room when the emergency department consults us about a baby with suspected infantile hypertrophic stenosis of the pylorus.
Do you know the characteristics of a child with suspected infantile hypertrophic stenosis of the pylorus?
Patients with suspected infantile hypertrophic stenosis of the pylorus are usually between two and eight weeks old,
although this condition has been reported in babies as young as one week and...
Conclusion
Take-home points
In a baby who presents with vomiting between the ages of two and eight weeks,
we should consider infantile hypertrophic stenosis of the pylorus the first diagnostic option.
"πylorus": mnemonic for the measurements of the normal pylorus.
Normal US findings do not rule out infantile hypertrophic stenosis of the pylorus: if the symptoms persist or worsen (projectile vomiting),
it is necessary to repeat the study.
Not all cases of infantile hypertrophic stenosis of the pylorus result in total obstruction—in some cases gastric content...
References
1.
Askew N.
An overview of infantile hypertrophic pyloric stenosis.
Paediatric nursing.
2010;22:27-30.
2.
Hernanz-Schulman M.
Infantile hypertrophic pyloric stenosis.
Radiology.
2003;227:319-31.
3.
Panteli C.
New insights into the pathogenesis of infantile pyloric stenosis.
Pediatric surgery international.
2009;25:1043-52.
4.
Ramkumar D,SchulzeKS.
The pylorus.
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.
2005;17 Suppl 1:22-30.
5.
Lowe LH,
Banks WJ,
Shyr Y.
Pyloric ratio: efficacy in the diagnosis of hypertrophic pyloric stenosis.
Journal of ultrasound in medicine : official journal of...