Congenital Hypertrophic Pyloric Stenosis At A Tertiary Care Hospital: A Surgical Experience With 30 Infants
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 9
Abstract
Background: Congenital hypertrophic pyloric stenosis (CHPS), first described in 1888 by Harald Hirschsprung, is one of the most common cause of gastric outlet obstruction in infants. The incidence is approximately 1–4 per 1000 live births although the incidence differs in various regions and communities. It is usually seen in first born male infants and is characterized by projectile or forceful vomiting due to high pressure generated by the hypertrophied gastric muscles. No exact etiological cause is known but genetic and environmental factors are thought to be involved in etiopathegenesis. The diagnosis is usually established by ultrasonography which shows increased pyloric muscle thickness, length and diameter. Ramstedt's pyloromyotomy introduced in 1912, still remains the operative procedure of choice for management of CHPS. There is little published data regarding this condition in our setting hence we conducted this study to describe the clinical presentation, Ultrasound findings, post-operative complications and outcome in infants having CHPS. Aims and Objectives: (1)To study the incidence and demographic characteristics of patients with CHPS. (2) To study clinical presentation like projectile vomiting, palpable lump, jaundice and dyselectrolytemia in these patients. (3) To study USG findings like pyloric canal length and wall thickness. (4) To study operative outcomes in terms of cessation of vomiting. (5) To study complication like wound gaping, persistent vomiting and aspiration. Materials and Methods: This was a prospective cohort study comprising of 30 patients with CHPS. For this study infants presenting with non-bilious vomiting and ultrasonography features of CHPS were screened and included depending upon inclusion and exclusion criteria. All patients underwent detailed history, clinical examination, investigation and surgical treatment and they were studied for clinical features, investigation, management and morbidity and mortality patterns. The data was studied using complex statistical software. Results: The study comprised of 50 infants with congenital hypertrophic pyloric stenosis. Out of the 30 studied cases 20 were males and 10 were females with a M: F ratio of 1: 0.5. Predominantly first born children were affected (70%) while CHPS was found in 9 cases (30%) who were second by order of birth. The most common age of presentation was 4-8 weeks (56.7%) followed by within 4 weeks (33.3%) and 8-12 weeks (10%). The analysis of children with respect to their expected weight revealed that 23 (76.6%) infants had normal weight while 7 (23.4%) infants had weight less than expected foe their age. As expected in CHPS all infants had non bilious vomiting. There was no patient with associated congenital anomalies. In 2 (6.7%) infants there was a family history of CHPS in 1st or 2nd degree relatives. Jaundice and constipation was present in 5 (16.67 %) and 3 (10 %) patients respectively. On clinical examination abdominal distension, palpable epigastric lump, visible peristalsis and was present in 22 (73.3%), 14 (46.7%) and 8 (26.7%) infants respectively. All patients had some form of dehydration. Mild and moderate dehydration was present in 22 (73.3%) and 8 (26.7%) patients respectively. Hyponatremia and hypokalemia was present in 7 (23.3%) and 9 (30%) www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v5i9.99 Dr Kawadu S. Jawade et al Volume 05 Issue 09 September 2017 Page 27949 JMSCR Vol||05||Issue||09||Page 27948-27956||September 2017 patients respectively. Ultrasound examination of the cases revealed that pyloric thickness was more than 4 mm in 24 (80%) infants and pyloric length was more than 16 mm in 29 (96.7%) cases. The sensitivity of ultrasound examination for diagnosis of CHPS was found to be 97%. Isolyte P alone (50%) or in combination with DNS (13.3%) or RL (36.7%) was used to correct electrolyte imbalance before surgery. In post-operative period a combination of Isolyte P and Ringers lactate was used in majority (53.3%) of the infants. Ramstedt's pyloromyotomy was done in all the infants with CHPS. In majority of the infants (79.3%) feeding was started within 72 hours after surgery. The most common postoperative complications seen in studied cases were respiratory tract infection (20%) followed by vomiting (16.7%) and wound gaping (10%). 14 (46.7%) patients remained under follow up while 16 (53.3%) were lost to follow up. Growth and development was found to be satisfactory in infants who were brought for regular follow up. Conclusion: Congenital hypertrophic pyloric stenosis is most common cause of infantile gastric outlet obstruction with most common age of presentation between 4 to 8 weeks of life with a male preponderance. The condition can be diagnosed by ultrasonography and Ramstedt's pyloromyotomy is still procedure of choice for treatment of these patients. Keywords: Congenital hypertrophic pyloric stenosis, Ultrasonography, Surgical management, Ramstedt's pyloromyotomy, outcome.
Authors and Affiliations
Dr Kawadu S. Jawade
Keywords
Related Articles
- EP ID EP528321
- DOI -
- Views 90
- Downloads 0
Detection of Vancomycin susceptibility including h-VISA among Methicillin resistant Staphylococcus aureus and Staphylococcus species isolated from orthopaedic device associated infections in a tertiary care hospital
Globally, Staphylococcus aureus is the major causative organism for medical device associated infections. Of this, the proportion of Methicillin resistant Staphylococcus aureus (MRSA) has worldwide for the last two decad...
Comparism of Presence of Foot and Mouth Disease Antibodies using Liquid Phase Blocking Elisa in Market and Ranch Cattle in Umuahia Abia State, Nigeria
A serological study was conducted to ascertain the presence of Foot and Mouth Disease (FMD) in cattle in three cattle farms and two cattle markets in Abia State. Eighty-eight sera were screened for FMD antibodies using t...
Tubercle of Zuckerkandl as a Landmark for Identification of Recurrent Laryngeal Nerve Enabling Safe Thyroid Surgery- A Prospective Comparitive Study
Introduction: During thyroid surgery identification of Recurrent laryngeal nerve (RLN) is an essential step,as any injury to it will lead to hoarseness or loss of voice. Tubercle of zuckerkandl (TZ), a projection from th...
Psychiatric Stigma among Medical Students and Nurses: Study From Rural Bihar, India
Stigmatic attitude toward psychiatric patients are universal rather than cultural phenomenon. However it has a large impact on help seeking behavior of patients and caregiving if it is significantly present in medical pe...
Suture rectopexy in the Management of Rectal prolapse in adults
Complete rectal prolapse is a circumferential full thickness descent of the rectum, which should be differentiated from prolapsing hemorrhoids, one of the common surgical problems we encounter which were treated by eithe...