Clinical findings versus imaging studies in the diagnosis of infantile hypertrophic pyloric stenosis

Abstract

Background: Infantile hypertrophic pyloric stenosis is the most common surgical cause of vomiting in early infancy and can be diagnosed clinically or by imaging studies.

Objectives: The aim of this study was to assess the accuracy of clinical examination compared with ultrasound and upper gastrointestinal contrast imaging in the diagnosis of infantile hypertrophic pyloric stenosis.

Patients and methods: A prospective analysis was carried out of 60 patients referred to the Pediatric Surgical Department with a proven diagnosis of infantile hypertrophic pyloric stenosis on surgical exploration in the period from January 2010 to January 2014. All patients underwent clinical, radiological, and sonographic evaluations.

Results: The male to female ratio was 3.28 : 1. The mean age at onset was 29.5 days. The mean age at presentation was 48 days. Projectile vomiting was present in all infants (100%). A pyloric mass was palpable in 31 (51.66%) infants, visible peristaltic waves were noted in 24 (40%) infants, and 54 (90%) patients had gastric aspirate of more than 10 ml. Ultrasound examination was confirmatory in all patients (100%). Barium study was positive in 55 (91.66%) cases.

Conclusion: A palpable pyloric mass with a suggestive history is a sufficient indication for proceeding to surgical treatment without confirming diagnostic imaging studies. However, when physical findings alone are inconclusive, an abdominal ultrasound examination should be performed because of their high accuracy in identifying the underlying problems.

Keywords: abdominal ultrasound, barium meal, infant, pyloric stenosis