RADIOLOGIC ASSESSMENT IN ONE MONTH OLD INFANT WITH NON-BILIOUS VOMITING:
A CASE REPORT OF HYPERTROPHY PYLORIC STENOSIS
Abstract
BACKGROUND : Hypertrophy pyloric stenosis
(HPS) defined as idiopathic thickening of the
gastric pyloric muscle resulting in gastric outlet
obstruction. We report radiologic features of HPS
in one month old infant.
METHOD : An one month old baby boy brought
to the ER because of vomit in form of milk and
drinks he takes orally, greenish vomit was denied.
RESULT : Patient's abdominal radiograph shows
gastric dilatation with absence of intestinal air
distal to the stomach forming “single bubble
appereance”. To confirming the diagnosis on the
abdominal radiograph we do an abdominal
ultrasound concerning to pyrolus region.
CONCLUSION : The role of radiology is
important in HPS. Abdominal radiograph shows
dilated stomach and absence of intestinal air distal
to the stomach, as a characteristic "single bubble
appereance". Meanwhile in ultrasound, pyloric
muscle thickness greater than 3mm, pyloric
muscle length greater than 15-17mm, and pyloric
transverse diameter greater than 13mm, are strong
diagnostic criteria for HPS.
Introduction
HPS refers to the thickening of gastric
pyloric musculature which results in
progressive gastric outlet obstruction.
Incidence of HPS approximately 2-5 per
1,000 births, with 4:1 predilection for
males than females.
Muhammad Afdhal, Damayanti Sekarsari
Departement of Radiology, Cipto Mangunkusumo National Referral Center Hospital, Jakarta, Indonesia.
Case Description
One month old baby boy brought by his
mother to the ER with main complaint of
vomit about ten minutes after feeding.
Greenish vomit was denied. He was
lethargic and moderately dehydrated.
There was no palpable mass found on
abdominal physical examination.
Anteroposterior and lateral view
abdominal radiograph was ordered.
Method
The abdominal radiograph shows gastric
dilatation and absence of intestinal air
distal to the stomach forming a “single
bubble appereance”, with air-fluid level
appereance on the lateral cross table view
which consistent to hypertrophic pyloric
stenosis.
Then we do abdominal ultrasound with
concern focus to pyloric region
confirmed the diagnosis to hypertrophy
pyloric stenosis. The pylorus appears
thickened, with 5,1 mm in a single
muscle thickness and 25,2 mm in length.
Result
Intraoperative findings showed
thickening of the gastric pyloric muscle
with pylorus length up to 3 cm, identical
to pyloric length in ultrasound
examination. Pyloromyotomy procedure
was done on the patient.
Conclusion
Single bubble appearance on abdominal
radiographs can support the diagnosis of
hypertrophy pyloric stenosis.
Ultrasonography diagnostic criteria of
patient with suspected hypertrophy
pyloric stenosis could show diameter of a
single muscle wall >3mm (A), pyloric
length > 15 - 17mm (B), and pyloric
transverse diameter >13mm (C).
Nowadays, US considered as a gold
standard by many investigators in HPS
case.
Refference
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