Morning Meeting

2017-10-30

Hung Ching Hsien

Pediatric surgery
 Case report
 P06459, 吳 X X 之 子
 1 M/O , male
 C/S ( 屏基 )
 G2P2AA1 mother
 BBW 3100gm
 GA : 37+5 weeks
 C.C : vomiting occasionally 1 week ago
 vomiting after feeding
 projectile vomiting for 2+ days
 屏基 兒科急診
 Admission : 2017-1-13
 Impression :
-- infantile hypertrophic pyloric stenosis
 Sonogram ,UGI series : 2017-10-13
 2107-10-13
 Impression : IHPS
 OP : pyloromyotomy ,
Fredet-Ramstedt
 Op finding :
-- Pylorus mass : 2.5x1.5x1.5 cm
-- Pyloric stenosis,obstruction
-- Muscle thickness : 0.5-0.6 cm
P 06459 吳 XX 之子
P 06459 吳 XX 之子
 Case report
 Y69169, 吳 X 右
 45 D/O , male
 IHPS
 OP : 2015-10-20
 Op finding :
-- Pylorus mass : 2x1.5x1.5 cm
-- Pyloric stenosis,obstruction
-- Muscle thickness : 0.6 cm
 Infantile hypertrophic
pyloric stenosis (IHPS )
 Pyloric stenosis is a narrowing of the pylorus(t
he opening from the stomach into the duoden
um), due to enlargement (hypertrophy) of the
muscle surrounding this opening (the pylorus,
meaning "gate"), which spasms when the sto
mach empties.
 This condition causes severe projectile non-bil
ious vomiting .
 It most often occurs in the first few months of
life, when it may thus be more specifically lab
eled as infantile hypertrophic pyloric sten
osis.
 Epidemiology
 Infantile hypertrophic pyloric stenosis (IHPS) occur
s in approximately 2 to 3.5 per 1000 live births, alt
hough rates and trends vary markedly from region
to region
 It is more common in males than females (4:1 to 6
:1) and in infants born preterm as compared with
those born at term
 Approximately 30 to 40 percent of cases occur in fi
rst-born children (approximately 1.5-fold increased
risk) , and it is less common in infants of older mot
hers .
 Symptoms usually begin between 3 and 5 weeks of
age, and very rarely occur after 12 weeks of age .
 Cause
 Normally, food passes easily from the stomach int
o the first part of the small intestine through a va
lve called the pylorus. With pyloric stenosis, the
muscles of the pylorus are thickened. This preven
ts the stomach from emptying into the small intes
tine.
 The cause of the thickening is unknown. Genes m
ay play a role, since children of parents who had
pyloric stenosis are more likely to have this condi
tion.
 Pyloric stenosis occurs most often in infants youn
ger than 6 months. It is more common in boys th
an in girls.
 symptoms
 Vomiting is the first symptom in most children:
Vomiting may occur after every feeding or only after some
feedings
Vomiting usually starts around 3 weeks of age, but may start
any time between 1 week and 5 months of age
Vomiting is forceful (projectile vomiting)
The infant is hungry after vomiting and wants to feed again
 Other symptoms appear several weeks after birth and may
include:
Abdominal pain
Burping
Constant hunger
Dehydration (gets worse as vomiting gets worse)
Failure to gain weight or weight loss
Wave-like motion of the abdomen shortly after feeding and
just before vomiting occurs
 Exams and Tests
 A physical exam may reveal:
--Signs of dehydration, such as dry skin and mouth,
less tearing when crying, and dry diapers
--Swollen belly
--Olive-shaped mass when feeling the upper belly,
which is the abnormal pylorus
 Ultrasound of the abdomen may be the first

imaging test. Other tests that may be done include:

 Barium x-ray -- reveals a swollen stomach and

narrowed pylorus
 Blood tests -- often reveals an electrolyte

imbalance
 Treatment
 Treatment for pyloric stenosis involves surge
ry to widen the pylorus. The surgery is called
pyloromyotomy.
 If putting the infant to sleep for surgery is no
t safe, a device called an endoscope with a
tiny balloon at the end is used. The balloon i
s inflated to widen the pylorus.
 In infants who cannot have surgery, tube fee
ding or medicine to relax the pylorus is tried.
 Surgery usually relieves all symptoms. As so
on as several hours after surgery, the infant
can start small, frequent feedings.
Thanks