Infantile Hypertrophic Pyloric Stenosis: A Survey by the Korean Association of Pediatric Surgeons

Kim, I K; Kim, S Y; Kim, S K; Kim, W K; Kim, J E; Kim, J C; Kim, H H; Park, K W; Park, Y S; Park, W H; Song, Y T; Yang, J W; Oh, S M; Yoo, S Y; Lee, D S; Lee, M D; Lee, S K; Lee, S C; Chang, S I; Chung, S Y; Chung, E S; Jung, P M; Choi, K J; Choi, S O; Choi, S H; Huh, Y S; Hong, C; Whang, E H

Abstract

Thirty three members of the Korean Association of Pediatric Surgeons were surveyed to determine the clinical manifestations and current management of infantile hypertrophic pyloric stenosis (IHPS). The members completed a registration form and a questionnaire that indicated their treatment preferences for patients treated during 1996. The response rate was 84.8 %, and 23 institutions participated. Three hundred and sixty-three cases of IHPS were analysed. The male to female ratio was 5.15: 1. The presenting symptoms were nonbilious vomiting in 363 cases(lOO %), palpable mass in the upper abdomen in 200 cases (55.1 %) and visible peristaltic waves in 67 cases(l8.5 %). Fluid therapy was done in 161 cases(44.4 %) for preoperative preparation. Twenty patients(5.5 %) were premature. There were 27 low birth weight babies(7.7 %). The onset of symptoms ranged from 1 to 14 weeks of age with a peak occurrence at 2 to 4 weeks of age. Two hundred and thirty-six cases(66.6 %) presented within 4 weeks of age. There was one set of male twins and a family history of twins. The modes of feedings were: breast feeding; 69 cases(24.5 %), formula feeding; 176 cases(62.4 %) and mixed feeding; 37 cases(l3.l %). The preferred diagnostic modalities were ultrasonography (US) 229 cases(63.l %), UGI series 27 cases(7.4 %) and US and UGI series combined 86 cases(23.7 %). Only 21 cases(5.8 %) were operated on without imaging study, ie. with positive physical finding. Perforation of the mucosa during pyloromytomy occurred in 5 cases. All were treated successfully with primary closure. Persistent vomiting over 2 weeks after operation were reported in 5 cases. Three wound infections, one aspiration pneumonia and one postoperative bleeding were reported. There was no mortality in 363 cases.