Clinical experience of infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is a relatively common disease. We report our experience with 24 IHPS infants admitted to the Departments of Pediatrics and Pediatric Surgery of Chang Gung Memorial Hospital in Kaohsiung over 4 years, from 1986 to 1989. Analysis disclosed a high male to female ratio (11:1) and a heavy preponderance of firstborn male (46%). Fifty per cent of our cases had symptoms beginning between the ages of 2-4 weeks. The fact that 67% of the patients had duration of symptoms longer than 2 weeks prior to admission, with a mean interval of 25 days of progressive symptoms, represented that there was delay in diagnosis and treatment in most of our cases. The major clinical manifestations were projectile vomiting (100%), palpable pyloric mass (66.7%) and visible gastric peristaltic waves (41.7%). Of the 18 cases receiving plain supine abdominal roentgenogram, 17 (94.4%) demonstrated typical pictures. A gastric air outline extending below L2 vertebra is the most helpful criteria. Preoperative sonography suggested that the determination of pyloric muscle wall thickness predicted IHPS more accurately than that of pyloric muscle length. All 24 cases received Fredet-Ramstedt pyloromyotomy, with no mortality and short hospitalizations.