Infantile hypertrophic pyloric stenosis: a single institution’s experience

Abstract

Background/purpose Infantile hypertrophic pyloric stenosis (IHPS) is said to be relatively common in the western world, but its incidence in the Kingdom of Saudi Arabia is unknown. We set out to study the incidence of IHPS in children presenting at our hospital and review the clinical presentation and treatment outcomes of such patients.
Patients and methods A retrospective chart review of all cases with IHPS admitted to a tertiary hospital, Riyadh Military Hospital, over 18 years (1990–2008) was conducted. Diagnosis was confirmed by ultrasonography according to the length of the pyloric channel and thickness of the pyloric muscles. An analysis of demographic data, clinical presentation, diagnostic modality, and associated congenital anomalies was carried out. Operative technique, postoperative course, and complication rates were identified.
Results The review of the medical records showed 22 patients with a diagnosis of IHPS. The incidence rate of IHPS was 1.4/10 000 live births. Demographically, most cases presented in the first month of life. It is more common in boys. In all, 55% of infants were first borns. Clinically, nonbilious projectile vomiting was the main symptom. Mild dehydration was found in half of the cases with alkalotic changes. Ultrasonography was the main diagnostic modality in 82% of cases. Others were diagnosed by contrast study. Open Ramstedt pyloromyotomy was the surgical approach in 20 (91%) cases and the laparoscopic approach in 2 cases (9%). Fourteen (14%) patients had an associated congenital inguinal hernia. The mean length of hospital stay was 5.5 days. The most common postoperative complication was wound infection in 4.5% of patients. Incidence of IHPS had obvious seasonal association.
Conclusion Incidence of IHPS at our hospital (the biggest hospital in the Kingdom of Saudi Arabia with an annual birth record of 14 000) is far less common than international incidences reported in North America and Europe. More reports from Saudi Arabia, the Middle East, and Asia are recommended to support the rarity of IHPS in this region of the world. Seasonal variation suggests a possible etiological role for environmental factors. It is of practical use for both epidemiologists and clinicians for future comparability.

Keywords: incidence, infantile pyloric stenosis, risk factors