Pediatrics & Neonatology
Volume 50, Issue 3 , Pages 117-120, June 2009

Sonogram Before and After Pyloromyotomy: The Pyloric Ratio in Infantile Hypertrophic Pyloric Stenosis

  • Yu-Lan Huang

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • Department of Pediatrics, Taipei Medical University, Taipei, Taiwan
    • ,
  • Hung-Chang Lee

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • Department of Pediatrics, Taipei Medical University, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Pediatrics, Mackay Memorial Hospital, Taipei 92, Section 2, Chung-San North Road, Taipei, Taiwan
    • ,
  • Chun-Yan Yeung

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing, and Management College, Taipei, Taiwan
    • ,
  • Wai-Tao Chen

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Chuen-Bin Jiang

      Affiliations

    • Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
    • Mackay Medicine, Nursing, and Management College, Taipei, Taiwan
    • ,
  • Jin-Cherng Sheu

      Affiliations

    • Department of Pediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan
    • ,
  • Nien-Lu Wang

      Affiliations

    • Department of Pediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan

Received 27 August 2008; received in revised form 5 November 2008; accepted 29 December 2008.

Article Outline

Background

Sonography is used to diagnose infantile hypertrophic pyloric stenosis, but little information is available about the appearance of postoperative sono-graphs. The purpose of this study was to evaluate the morphology of the pylorus in association with an obstruction before and after pyloromyotomy.

Methods

Pyloric length, diameter, muscle thickness and intermuscular space were measured sonographically at diagnosis and daily after pyloromyotomy until discharge in 12 infants with infantile hypertrophic pyloric stenosis. The ratios of pyloric wall thickness and intermuscular space to the entire pyloric diameter were measured.

Results

The pylorus still appeared hypertrophied after pyloromyotomy on the sono-grams. The traditional measurement of linear dimensions of the pylorus was not significantly changed from the preoperative values by the time of discharge, except for muscle thickness. The intermuscular space increased from 4.8 ± 0.8 mm preoperatively to 7.3 ± 2.1 mm by postoperative day 3 (p= 0.10). Lowe's pyloric ratio at diagnosis was a mean of 0.32, decreasing to 0.29 on postoperative day 3 and 0.29 on the day of discharge (p = 0.82). The alternative pyloric ratio increased significantly by postoperative day 2 (0.24 ± 0.09 on day 2 vs. 0.11 ± 0.07 preoperatively, p = 0.02).

Conclusion

The pyloric ratio appears to be a reliable parameter in evaluating the regression of pyloric stenosis after pyloromyotomy, and also aids in the diagnosis of pyloric stenosis.

Key Words:  infantile hypertrophic pyloric stenosis , pathogenesis , pyloric ratio , pyloromyotomy , sonography

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Ball TI , Atkinso GO , Gay BB . Ultrasound diagnosis of hypertrophic pyloric stenosis: real-time application and demonstration of a new sonographic sign . Radiology . 1983;147:499–502
  2. Blumhagen JD , Maclin L , Krauter D , et al.   Sonographic diagnosis of hypertrophic pyloric stenosis . Am J Roentgenol . 1988;150:1367–1370
  3. Ito S , Tamura K , Nagae I , et al.   Ultrasonographic diagnosis criteria using scoring for hypertrophic pyloric stenosis . J Pediatr Surg . 2000;35:1714–1718
  4. Lamki N , Athey PA , Round ME , et al.   Hypertrophic pyloric stenosis in the neonate-diagnostic criteria revisited . Can Assoc Radiol . 1993;44:21–24
  5. Lee HC , Chiou JY , Yeh HJ . Sonographic diagnosis of infantile hypertrophic pyloric stenosis . J Ultrasound Med . 1989;6:261–265
  6. Blumhagen JD . The role of ultrasonography in the evaluation of vomiting in infants . Pediatr Radiol . 1986;16:267–270
  7. Hernanz-Schulman M . Infantile hypertrophic pyloric stenosis . Radiology . 2003;227:319–331
  8. De Caluwe D , Reding R , de Ville de Goyet J , et al.   In traabdominal pyloromyotomy through the umbilical route: a technical improvement . J Pediatr Surg . 1998;33:1806–1807
  9. Leinwand MJ , Shaul DB , Anderson KD . The umbilical fold approach to pyloromyotomy: is there a safe alternative to the right upper quadrant approach? . J Am Coll Surg . 1999;189:362–367
  10. Okorie NM , Dickson JA , Carver RA , Steiner GM . What happens to the pylorus after pyloromyotomy? . Arch Dis Child . 1988;63:1339–1341
  11. Yoshizawa J , Eto T , Higashimoto Y , et al.   Ultrasonographic features of normalization of the pylorus after pyloromyotomy for hypertrophic pyloric stenosis . J Pediatr Surg . 2001;36:582–586
  12. Lowe LH , Banks WJ , Shyr Y . Pyloric ratio: efficacy in the diagnosis of hypertrophic pyloric stenosis . J Ultrasound Med . 1999;18:773–777
  13. The International Pediatric Endosurgery Group Guidelines Committee  . Guidelines for Surgical Treatment of Infantile Hypertrophic Pyloric Stenosis. Los Angeles . Available at: http://www.ipeg.org/guidelines/pyloric [Date accessed: Feb 28, 2008]
  14. Hallam D , Hansen B , Bodker B , et al.   Pyloric size in normal infants and in infants suspected of having hypertrophic pyloric stenosis . Acta Radiologica . 1995;36:261–264
  15. Tander B , Akalin A , Abbasoglu L , et al.   Ultrasonographic follow-up of infantile hypertrophic pyloric stenosis after pyloromyotomy: a controlled prospective study . Eur J Pediatr Surg . 2002;12:379–382
  16. Eisenberg MM , Fondacaro PF , Dunn DH . Applied anatomy and anomalies of the stomach . In:  Haubrich WS ,  Schaffner F ,  Berk JE editor. Gastroenterology . Philadelphia: WS Saunders Company; 1995;p. 561–581
  17. Ohshiro K , Puri P . Pathogenesis of infantile hypertrophic pyloric stenosis: recent progress . Pediatr Surg Int . 1998;13:243–252
  18. Guarino N , Shima H , Puri P . Structural immaturity of the pylorus muscle in infantile hypertrophic pyloric stenosis . Pediatr Surg Int . 2000;16:282–284
  19. Muramori K , Nagasaki A , Kawanami T . Ultrasonographic serial measurements of the morphologic resolution of the pylorus after Ramstedt pyloromyotomy for infantile hypertrophic pyloric stenosis . J Ultrasound Med . 2007;26:1681–1687

PII: S1875-9572(09)60046-2

doi:10.1016/S1875-9572(09)60046-2

Pediatrics & Neonatology
Volume 50, Issue 3 , Pages 117-120, June 2009

Article Tools