Infantile hypertrophic pyloric stenosis: Perspective from a developing country

Authors

  • Kashaf Khalid Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
  • Saman Hamid Medical College, Aga Khan University, Karachi, Pakistan
  • Muhammad Mussab Khakwani Medical College, Aga Khan University, Karachi, Pakistan
  • Areej Salim Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
  • Shabbir Hussain Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.

DOI:

https://doi.org/10.46831/jpas.v2i2.153

Keywords:

Hypertrophic pyloric stenosis, Pediatric, Surgery, Feed

Abstract

Background: Infantile hypertrophic pyloric stenosis (IHPS) is pyloric muscle hypertrophy that causes gastric outlet obstruction. This study explores the prevalence of IHPS and the challenges in its diagnosis and treatment in a developing country. The study aimed to identify factors contributing to delays in the diagnosis and treatment of IHPS and compare the management practices for IHPS at the study hospital with international surgical guidelines.

Methods: A retrospective cross-sectional study was conducted at The Aga Khan University Hospital. Data were collected from records of 126 pediatric patients diagnosed with IHPS between January 2015 and 2019. Quality parameters, including delay in presentation, diagnosis, referral, surgery, diagnostic modalities, surgical practice, post-operative feeding, and hospital stay, were assessed. Statistical analysis was performed using SPSS version 22.

Results: Of the 44 included patients, the majority (84%) were male. The mean age at presentation was 5.2 weeks. Ultrasound was the primary diagnostic modality (81.8%), with upper GI studies used in 11.3% of cases. Delays in presentation and diagnosis were observed, with parents' delay being a major factor. The mean lag time between symptoms and surgical consult was 11.2 days, contributing to delays. Complications correlated with increased lag times.

Conclusion: This study reveals variations in IHPS management compared to international guidelines. The hospital predominantly uses an open Ramsted's pyloromyotomy, while laparoscopic surgery is recommended. Postoperative feeding initiation and discharge practices differ from international standards. Delays in diagnosis result from the disease's rarity and a lack of trained surgeons. The study underscores the need to educate primary care physicians and parents for early IHPS referral. IHPS management can be optimized by addressing delays, improving surgical practices, and ensuring early referral and intervention.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

El-Gohary Y, Abdelhafeez A, Paton E, Gosain A, Murphy AJ. Pyloric stenosis: an enigma more than a century after the first successful treatment. Pediatr Surg Int [Internet]. 2018;34(1):21–7. Available from: https://doi.org/10.1007/s00383-017-4196-y

Jobson M, Hall NJ, Bchir MB. Seminars in pediatric surgery contemporary management of pyloric stenosis. Semin Pediatr Surg. 2016;25(4):219–24.

Zhu J, Zhu T, Lin Z, Qu Y, Mu D. Perinatal risk factors for infantile hypertrophic pyloric stenosis: A meta-analysis. Journal of pediatric surgery. 2017 Sep 1;52(9):1389-97.

Kirby RS. Infantile hypertrophic pyloric stenosis: Epidemiology, genetics, and clinical update. Adv Pediatr. 2011;58(1):195–206.

Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis (IHPS) in infants and children: Evidence-based emergency imaging. In: Kelly A, Cronin P, Puig S, Applegate KE, editors. Evidence-Based Emergency Imaging: Optimizing Diagnostic Imaging of Patients in the Emergency Care Setting [Internet]. Cham: Springer International Publishing; 2018. p. 555–65. Available from: https://doi.org/10.1007/978-3-319-67066-9_35

Cheema HA. Utility of endoscopy in infantile hypertrophic pyloric stenosis. Journal of the Pakistan Medical Association. 2003;53(10):482-3.

Ross AR, Johnson PRV. Infantile hypertrophic pyloric stenosis. Surg [Internet]. 2019 Nov 1 [cited 2019 Nov 24];37(11):620–2. Available from: https://www.sciencedirect.com/science/article/pii/S0263931919301917

Dalton BGA, Gonzalez KW, Boda SR, Thomas PG, Sherman AK, St SD. Optimizing fluid resuscitation in hypertrophic pyloric stenosis. J Pediatr Surg. 2016;51(8):1279–82.

Staerkle RF, Lunger F, Fink L. Open versus laparoscopic pyloromyotomy for pyloric stenosis. Cochrane Database Syst Rev. 2021;3(3):CD012827. doi: 10.1002/14651858.CD012827.pub2.

Kawahara H, Takama Y, Yoshida H. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the "olive"? J Pediatr Surg. 2005;40(12):1848-51. doi: 10.1016/j.jpedsurg.2005.08.025.

Published

2024-03-22

How to Cite

1.
Khalid K, Hamid S, Khakwani MM, Salim A, Hussain S. Infantile hypertrophic pyloric stenosis: Perspective from a developing country. J Pediatr Adolesc Surg [Internet]. 2024Mar.22 [cited 2024Apr.17];2(2). Available from: http://jpedas.org/ojs/index.php/jpedas/article/view/153
Share |