Infantile hypertrophic pyloric stenosis: profile, management and outcome of patients admitted to a tertiary hospital in Bloemfontein, South Africa

Abstract

Background: Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-  born males. It usually presents with projectile, non-bilious vomiting. Late presentation leads to severe dehydration and malnutrition with deranged  serum-electrolytes and acid-base imbalance delaying treatment and prolonging hospital stay. This study aims to evaluate the profile, management and  outcome of IHPS at a tertiary hospital in Bloemfontein, South Africa.

Methods: The study was a retrospective, descriptive record review including all patients with IHPS admitted to Universitas Hospital from January 2008 to  February 2016. Of the 22 patients admitted, files for 19 patients were available for inclusion.

Results: Sixteen (84.2%) of the 19 patients were male. Of the 11 patients with available birth order, two were first-, two second-, six third- and one fourth-  born. The patients’ ages ranged from 27 to 194 days (median 51 days). The most common symptoms were projectile vomiting (78.9%) and poor weight  gain (68.4%). Six patients had no ultrasound done, and 17 patients underwent a Ramstedt-pyloromyotomy. Eight patients received atropine as part of  their initial management. The duration of symptoms ranged from 1 to 58 days (median 14 days). There was no reported mortality. The length of stay  ranged from 2 to 60 days (median 7 days).

Conclusion: The gender distribution and age at presentation were in keeping with the literature but not the  birth order. The delay before surgery emphasises the poor general health and deranged biochemical state the patients present at the hospital.