Ultrasonography of pylorospasm: findings may simulate hypertrophic pyloric stenosis.

We compared sonographic images and measurements of patients diagnosed as having hypertrophic pyloric stenosis and pylorospasm among infants with projectile vomiting. Thirty-seven patients with hypertrophic pyloric stenosis had an unchanged pyloric length (mean, 22.5 mm) and muscle wall thickness (mean, 5.3 mm). Thirty-four pylorospasm patients had considerable variability in measurement or image appearance during their studies. Means of their longest or largest measurements were 14.4 mm for pylorus length and 3.8 mm for muscle wall thickness. Among these, 53% had muscle wall thickness of 4 mm or greater and 18% had pyloric length of 18 mm or greater during some portion of their study. We concluded (after clinical follow-up study confirmed our ultrasonographic diagnoses) that pylorospasm may mimic hypertrophic pyloric stenosis for at least a portion of a sonographic study. Muscle wall thickness or pyloric length measurements may overlap those accepted as positive for hypertrophic pyloric stenosis. Image or measurement variability is an important clue for diagnosing pylorospasm.     

Ultrasound diagnosis of evolving pyloric stenosis

Two infants with recurrent episodes of vomiting had upper gastrointestinal barium studies that did not show radiographic features of pyloric stenosis. However, follow-up abdominal sonograms done 1–2 weeks later documented hypertrophic pyloric stenosis, which led to surgery. This entity is not congenital, but an evolving acquired lesion. Therefore, ultrasound is an excellent modality to evaluate and monitor patients clinically suspected of developing hypertrophic pyloric stenosis despite their initially negative imaging studies.     

The sonographic double-track sign: not pathognomonic for hypertrophic pyloric stenosis; can be seen in pylorospasm.

OBJECTIVE: The "double-track" sign has previously been reported as specific for hypertrophic pyloric stenosis when noted on an upper gastrointestinal series. The sign has been noted on sonographic examinations as well. We sought to determine whether this sign can also be seen in cases of pylorospasm diagnosed by sonography, proving it not to be pathognomonic for hypertrophic pyloric stenosis. METHODS: The data obtained prospectively from 91 consecutive patients studied between 1999 and 2002 by sonography for projectile vomiting were retrospectively reviewed. Cases with diagnoses of hypertrophic pyloric stenosis or pylorospasm were reviewed for the imaging finding of the double-track sign. RESULTS: Thirty-seven patients had a sonographic diagnosis of hypertrophic pyloric stenosis that was confirmed surgically. Twenty-six (70.2%) showed a sonographic double-track sign. Thirty-four patients had a sonographic diagnosis of pylorospasm that was confirmed by close clinical follow-up. Eighteen (52.9%) showed a sonographic double-track sign. CONCLUSIONS: The sonographic double-track sign can be seen in cases of pylorospasm as well as hypertrophic pyloric stenosis. It is not pathognomonic for hypertrophic pyloric stenosis.     

Pyloric ratio: efficacy in the diagnosis of hypertrophic pyloric stenosis.

We sought to define a weight independent, highly sensitive and specific measurement to diagnose hypertrophic pyloric stenosis. A retrospective review of 87 children was performed. We determined the pyloric ratio (wall thickness/pyloric diameter) and its relationship to weight and compared it to standard criteria. The average pyloric ratios in normal children and in those with hypertrophic pyloric stenosis were 0.205 and 0.325, respectively (P < 0.001). A pyloric ratio of 0.27 yielded a sensitivity and specificity of 96% and 94%, respectively. The pyloric ratio maintained a linear relationship to weight in normal patients and those with hypertrophic pyloric stenosis. We conclude the pyloric ratio can be a highly sensitive, specific, and weight independent indicator of hypertrophic pyloric stenosis.     

高频超声在婴幼儿先天性肥厚性幽门狭窄诊断中的应用

目的探讨高频超声在先天性肥厚性幽门狭窄（ＣＨＰＳ）中的应用价值。方法对３０例ＣＨＰＳ患儿的幽门管长度、厚度及幽门肌层厚度进行测量,并与手术结果及１０例正常婴儿进行比较。结果超声测量ＣＨＰＳ幽门管长度≥１５ｍｍ,幽门管厚度≥１０ｍｍ,幽门肌层厚度≥４ｍｍ,与正常婴儿比较均有显著性差异（Ｐ〈０．０１）,超声测量ＣＨＰＳ患儿幽门管厚度和幽门肌层厚度与手术中测量无显著性差异（Ｐ〉０．０５）。结论高频超声对     

Sonographic diagnosis of infantile hypertrophic pyloric stenosis.

Twenty-five consecutive sonographic examinations performed at Flinders Medical Centre for possible infantile hypertrophic pyloric stenosis (IHPS) were analyzed retrospectively. The results and a pyloric muscle index calculated by a formula using length, diameter, muscle thickness, and body weight were compared with the clinical outcome (surgery or conservative management). In the children without IHPS, the calculated pyloric muscle index was less than 0.2, whereas in infants with proven pyloric stenosis, the index was greater than 0.2 (P < 0.001). This result suggested that the published index upper limit of > 0.4 to 0.46 was not valid in our institution. Pyloric length to muscle thickness ratio was also found to predict IHPS. A simplified index, including only length and muscle thickness, is proposed, whereby length (mm) plus 3.64 times thickness (mm), when greater than 25, implies IHPS.     

The antral nipple sign of pyloric mucosal prolapse: endoscopic correlation of a new sonographic observation in patients with pyloric stenosis.

This study describes the antral nipple sign of pyloric mucosal prolapse, a newly delineated sonographic observation in patients with pyloric stenosis, correlates the endoscopic findings, and examines its prevalence and significance in 31 consecutive patients with pyloric stenosis. Fifty patients who did not have pyloric stenosis served as the control population. The antral nipple sign consists of visualization of prolapsed, hypertrophied pyloric mucosa protruding into the gastric antrum. Using the Wilcoxon scores (rank sums), there was no significant difference among the patients in age, weight, or pyloric muscle dimensions. Although the diagnosis of pyloric stenosis is made on the basis of muscle thickness, we have documented that the pyloric mucosa becomes redundant in infants with pyloric stenosis, permitting a fuller understanding of the anatomic correlate underlying the sonographic images.     

Radiographic findings after incomplete pyloromyotomy

The gastrointestinal series of 10 patients with persistent vomiting following pyloromyotomies for pyloric stenosis were reviewed. Four patients had incomplete pyloromyotomies and required reoperation. Their studies showed persistent obstruction with elongation and narrowing of the pyloric channel similar to preoperative studies, except that the proximal muscle mass was tapered in 3 of the 4 patients. Six patients with similar histories of postpyloromyotomy vomiting but who did not require repeat surgery had irregular but much wider pyloric channels, good gastric emptying, and gastroesophageal reflux.     

彩色多普勒超声诊断在先天性肥厚性幽门狭窄中的诊断价值

目的:研究彩色多普勒超声检查对先天性肥厚性幽门狭窄(chps)的诊断价值。材料与方法:回顾性分析我院76例手术证实的chps患者,与其彩超检查结果比较结果:76例患儿超声与手术符合率为92.1%;超声所测得幽门管长径平均(19.2±3.5)mm,幽门管直径(14.1±3.1)mm,幽门肌厚度(6.1±1.2)mm,与手术所得结果进行比较,p0.05,差异无统计学意义。结论:彩色多普勒超声检查对chps有较高的确诊率,且无伤害,易操作。     

96例先天性肥厚性幽门狭窄的围手术期治疗与护理

目的:总结先天性肥厚性幽门狭窄的围手术期治疗与护理方法。方法:回顾性分析96例先天性肥厚性幽门狭窄患儿围手术期临床特点。结果:96例患儿均治愈,切口感染1例,切口裂开1例。结论:先天性肥厚性幽门狭窄围手术期护理与治疗应仔细、全面。精心、细致的治疗和护理是先天性肥厚性幽门狭窄患儿顺利恢复的关键。     

Pseudo-pyloric tumours

Two infants presenting with vomiting were thought to have palpable pyloric tumours. At operation hypertrophic pyloric stenosis was not present, but other conditions causing duodenal obstruction were, and these required surgical treatment. The cases illustrate that other abnormalities may masquerade as pyloric stenosis.     

Pseudo-pyloric tumours

Two infants presenting with vomiting were thought to have palpable pyloric tumours. At operation hypertrophic pyloric stenosis was not present, but other conditions causing duodenal obstruction were, and these required surgical treatment. The cases illustrate that other abnormalities may masquerade as pyloric stenosis.     

Long-term analysis of ultrasonic features of the antropyloric region 17–27 years after treatment of infantile hypertrophic pyloric stenosis

Long-term follow-up was performed 17 years to 27 years after conservative (n = 12) and operative (n = 36) treatment in 48 patients with infantile hypertrophic pyloric stenosis (IHPS). The follow-up examination included an interview to define any existing gastrointestinal symptoms and to determine whether a current disorder of the gastrointestinal tract was present; a clinical examination, including a scintigraphic determination of gastric emptying; as well as—for the first time—abdominal sonography emphasizing the antropyloric region. The sonographical examination included measurements of pyloric diameter and length, as well as wall and muscle thickness in the antropyloric region. The results were compared with data from a control group with the same age and gender distribution. No association was found between the sonographic parameters obtained, reported gastrointestinal symptoms, or altered gastric emptying times for solids and liquids. Clinically relevant disorders of stomach motility after IHPS appear to be a rare occurrence. © 1994 John Wiley & Sons, Inc.     

Does dehydration affect thickness of the pyloric muscle? An experimental study

Congenital hypertrophic pyloric stenosis (CHPS) is a common condition in infancy associated with smooth muscle hypertrophy and resulting in pyloric outlet obstruction. The final diagnosis of CHPS is based on precise ultrasonographic measurements of length and width of the pyloric muscle. Based on our clinical and sonographic experience, we observed that smaller measurements of the pyloric muscle were obtained in dehydrated infants than in children examined after proper fluid restoration. The clinical importance of these observations was evident because false-negative results could be obtained. An experimental animal work followed, proving our clinical observation to be true. A significant difference of about 30% to 50% was found between measurements of the muscle thickness of the gastric and pyloric muscles in a state of water deprivation, as compared with a state of full hydration (p < 0.05). Based on our preliminary results, we suggest that children with suspected CHPS should be well hydrated before the ultrasound (US) examination is performed, to avoid false-negative results and a consequent delay in treatment.     

高频超声在胃镜下幽门肌切开术治疗CHPS的应用价值

目的　旨在通过运用高频超声观察行胃镜下幽门环肌切开术治疗先天性肥厚性幽门狭窄(CHPS)前后肥厚狭窄的幽门管组织各层粘膜改变以及胃内液体通过幽门管情况,以探讨高频超声在此新型微创术式的应用价值和临床意义。方法　对65例CHPS的患儿进行超声检查,观察CHPS患儿术前与术后1天、术后1周、术后1个月、术后6个月幽门管各粘膜层厚度的改变以及幽门管内径变化。结果　手术后1天黏膜及黏膜下层厚度较手术前增加;术后1周及术后1个月幽门管长径、直径、幽门肌层厚度较手术前减小,黏膜及黏膜下层厚度无变化;手术后6个月幽门管长径、直径、幽门肌层厚度、黏膜及黏膜下层厚度均较手术前减少。术后胃内液体通过幽门管的次数较术前明显增多,幽门管开放程度增大。结论　根据高频超声所测得的胃镜下幽门肌切开术治疗CHPS前后的数据发现,幽门肌层和黏膜及黏膜下层厚度的变薄以及幽门管的狭窄程度改善,得出该微创术式是有效的手术方法,超声对其手术的疗效评估有重要的意义。     

腹腔镜手术治疗新生儿先天性肥厚性幽门狭窄的安全性与有效性

【目的】探讨腹腔镜手术治疗新生儿先天性肥厚性幽门狭窄的安全性及有效性。【方法】根据手术方式的不同将88例先天性肥厚性幽门狭窄新生儿分为腹腔镜手术的观察组和开腹手术的对照组,每组各44例,比较两组患儿的治疗效果及并发症情况。【结果】两组患儿的手术时间、术后进全奶时间、住院费用以及并发症发生率和术后呕吐发生率比较,差异均无统计学意义(P >0.05)。观察组患儿的住院时间及切口瘢痕长度均显著短于对照组,差异具有统计学意义(P <0.05)。【结论】腹腔镜手术治疗新生儿先天性肥厚性幽门狭窄,不仅能获得与开腹手术相当的疗效,还具有切口小、机体损伤轻、术后恢复快等优点。     

Ultrasonic "double track" sign in hypertrophic pyloric stenosis

Ultrasound has been used in the diagnosis of hypertrophic pyloric stenosis since the first reports of its use with contact B mode scanners. Real-time imaging has allowed measurements of pyloric diameter, length, and muscle wall thickness. Wall thickness measurements taken with the pylorus in longitudinal (elongated) view improve diagnostic accuracy. Fluid aided real-time examination of 10 cases showed the ultrasound equivalent of the "double track" sign. This finding is the result of pyloric fluid compressed into smaller tracks as it is impinged upon circumferentially by the thickened circular muscle. This sign, previously seen in barium studies, although nonspecific, may prove to be a sensitive diagnostic criterion.     

高频超声与X线钡剂造影对先天性肥厚性幽门狭窄诊断及分型的价值

目的 探讨高频超声与X线钡剂造影对先天性肥厚性幽门狭窄(CHPS)诊断与分型诊断的价值.方法 对以呕吐为主要症状的患儿常规进行高频超声和X线钡剂造影检查,并将两种检查方法加以对照.对经手术证实、资料完整的29例病例进行回顾性分析.正常组选取健康新生儿20例,并对其正常测值与CHPS组进行对比.结果 29例CHPS,超声诊断符合率100%,X线诊断符合率93.1%(27/29).CHPS组超声测量幽门管的长度均≥18 mm,幽门管直径≥14 mm,幽门管壁厚度≥4 mm,狭窄的管腔径均≤6 mm;X线测量幽门管长≥20 mm,管腔径≤7 mm,与正常组比较差异均有统计学意义(P＜0.01).根据幽门管腔狭窄和管壁增厚程度的影像表现,将CHPS分为轻型(Ⅰ)和重型(Ⅱ)两类,若4 mm≤幽门管壁厚≤6 mm,幽门管腔径＞3 mm为轻型;幽门管壁厚＞6 mm,幽门管腔径≤3 mm或呈闭塞状为重型.结论 CHPS的超声分型诊断具有一定的临床价值;高频超声对CHPS的诊断简便易行、准确可靠,避免了患儿吞钡和X线照射及减少吸人性肺炎的危险.     

Ultrasound follow-up of infantile hypertrophic pyloric stenosis (IHPS) during conservative therapy: ultrasound findings as criteria for diagnosis and cure

Purpose  During conservative therapy of infantile hypertrophic pyloric stenosis (IHPS) with atropine sulfate, there are many patients who do not achieve normal values of pyloric wall thickness and canal length even though they are clinically cured (vomiting has ceased); an objective criterion for cure has not yet been established. The aim of this study was to examine whether the appearance of pyloric wall stratification can be used as a criterion for cure. Methods  Twenty infants with IHPS who were treated conservatively were enrolled. Two of them ultimately required surgery. Ultrasound examinations were done serially and the pyloric wall thickness and canal length were measured. The echogenicity of the pyloric wall and the presence of wall stratification were noted. Results  On admission, all infants satisfied the ultrasound criteria for IHPS and had a heterogeneous pyloric wall without stratification. With conservative therapy, symptoms disappeared, the pyloric wall thickness and the canal length gradually decreased, the echogenicity gradually became homogeneous and hypoechoic, and wall stratification appeared (in most cases before the pyloric wall thickness and the canal length had normalized). The absence of wall stratification suggests that cellular interstitial changes, such as edema or inflammation, are present in the pyloric wall in the acute stage. Conclusion  Pyloric wall stratification was absent during the acute stage, but it appeared after initiation of treatment but before the pyloric wall thickness and the canal length had normalized. The presence of pyloric wall stratification can be used as a criterion for cure; the absence of wall stratification can be added to ultrasound diagnostic criteria for IHPS.     

Sonography of hypertrophic pyloric stenosis--attempt at prognostic evaluation based on sonographic criteria

Clinical and sonographic findings in 27 patients were analysed in a retrospective study in order to find sonographic criteria for the necessity of surgical treatment of infantile hypertrophic pyloric stenosis. Thirteen patients underwent surgical treatment, 14 were cured by conservative management only. Patients did not differ as regards clinical or serological findings when first investigated by means of sonography. On first examination, carried out about three days after the onset of symptoms, most of the patients who necessitated surgical treatment showed 1) a long canal segestorius (greater than 20 mm), 2) a significantly elevated muscle to lumen ratio exceeding 2:1, 3) pathological "target sign" in the medium upper stomach measuring more than 18 mm, 4) no passage of stomach contents to the duodenum on real time sonography examination. However, this constellation of features was also observed in some patients who were treated successfully by conservative management. Thus, although statistically significant differences were found between these two groups of patients, a definitive prospective decision in the individual patient with regard to the necessity of surgical treatment could not be obtained on the basis of the above-mentioned ultrasound signs. Our study suggests that sonographic criteria are helpful in establishing the diagnosis of infantile hypertrophic pyloric stenosis and also in evaluation of the response to therapeutic management, but--at the time of initial investigation--cannot provide accurate prognostic information.