Infantile hypertrophic pyloric stenosis (IHPS) is one of the common surgical abdomen in infancy, characterized by progressive non-bilious vomiting. The etiology is unknown, but it likely develops after birth. The pylorus of the stomach becomes thick and triggers progressive vomiting. Abdominal ultrasonography (US) is widely used as a diagnostic tool. Currently, there is a rare IHPS patient with severe metabolic derangement because of general use of abdominal US and its accuracy. We experienced a natural course of a 62- day-old male infant with IHPS who was suffering from intermittent vomiting, loss of weight but had not been properly treated for 1 month. It is needed to make an effort to diagnose differentially in recurrent vomiting infant and check-up regularly, and also educate parents properly.

Hypertrophic pyloric stenosis (HPS) is the most common infantile surgical condition and the standard treatment is open pyloromyotomy. Recently, laparoscopic techniques have rapidly advanced, and the laparoscopic approach has become widely adopted by pediatric surgeons. The aim of this study was to compare the clinical outcomes between open and laparoscopic pyloromyotomy. We retrospectively evaluated outcomes of pyloromyotomy for HPS by the open (OP) and the laparoscopic (LP) method. The procedures were performed at the Samsung Medical Center between September 2001 and March 2009. We analyzed patient age, sex, birth weight, length of hospital stay, postoperative length of stay (LOS), operating time, time to feeding commencement, postoperative vomiting frequency, the time to full feeding without vomiting, and surgical complications. A total of 54 patients were included in the study. There were 26 OP and 28 LP patients. There was no statistically significant difference in age, sex, birth weight, operating time, postoperative emesis. In contrast, postoperative LOS in the LP group was statistically significantly shorter than that in the OP group (2.0 vs. 3.3 days, p=0.0003) and time to full feeding was significantly shorter following LP. (p=0.018) There were no wound complications. Laparoscopic pyloromyotomy significantly reduced postoperative LOS and time to full feeding compared to open pyloromyotomy.

The purpose of this study is to evaluate the applicability of intravenous atropine sulfate therapy in infantile hypertrophic pyloric stenosis (IHPS). From 1998 to 2000 among 35 cases of IHPS, pyloromytomy was performed in 13 (Group A), and intravenous atropine was given as a primary therapy in 22 cases (Group B). In group A, all cases were cured completely. In group B, 13 (59 %) out of 22 cases were successfully treated with atropine, but 9 were failed therapy, and required operation. The recovery period to normal feeding and the hospital stay of the successful atropine group were longer than those of pyloromyotomy, 8.6 days vs. 2.9 days and 13.2 days vs. 4.1 days, respectively. In conclusion, intravenous atropine therapy did not replace pyloromyotomy, but it might be an alternative for the selected patients with contraindications for operation.

Infantile hypertrophic pyloric stenosis (IHPS) a common childhood disorders characterized by nonbilious projectile vomiting, an olive shaped mass in the right upper quadrant of the abdomen and visible gastric peristaltic wave in the upper abdomen. Its etiology and pathogenesis are not clear but abnormal nerve distribution of the pylorus has been postulated^2-6. We performed immunocytochemical staning to the pyloric muscle from 10 IHPS and 3 controls patients, utilizing specific monoclonal antibody to NCAM(neural cell adhesion molecule). In IHPS patients, the number of NCAM protein immunoreactive nerve fibers were less than that in normal subjects. Auerbach myenteric plexuse was well developed and interbundle nerve plexuse was present but nerve fibers supplying individual muscle cells in smooth muscle bundles were poorly developed. These results indicate reduction of innervation in smooth muscles in IHPS patients that possibly contributes to the pathogenesis of IHPS.

The pyloric length, diameter and muscle thickness were measured by ultrasonograms of 15 infants with infantile hypertrophic pyloric stenosis (IHPS) and were compared with the infants who came in for the routine vaccination randomly. This study analyzed the changes in pylorus for those who received pyloromyotomy using the ultrasonogram at 4 weeks and 8 weeks postoperatively, such as the time needed to become normalized, and compare with the size of the hypertrophic pylorus before the pyloromyotomy. According to Carver⁵, the pyloric muscle volume (PMV) and pyloric muscle index (PMI) were calculated in each case. The pyloric muscle volume, PMI and the thickness of pyloric muscle proved to be a more reliable guide to diagnose IHPS than length and diameter of pylorus. The pyloric muscle after pyloromyotomy was measured by ultrasound at 4 weeks and 8 weeks postoperatively. The pyloric muscle length, diameter, thickness and pyloric muscle volume were not normalized at 4 and 8 weeks postoperatively. However, pyloric muscle index was normalized at 4 weeks postoperatively which was probably due to rapid weight gain after pyloromyotomy.

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.

Infantile hypertrophic pyloric stenosis(IHPS) is common in full-term babies, and relatively rare in prematures. The diagnosis of IHPS in premature infants may be obscured because of the lack of classic symptoms and signs and the absence of the standard criteria for ultrasonic diagnosis. The purpose of this study is to discover the clinical differences between premature and full-term infants with pyloric stenosis, and determine the appropriate diagnostic methods for early diagnosis in premature infants. The clinical records of 52 IHPS patients who had been operated upon from October, 1994 to April, 1997 were reviewed. The incidence of IHPS in premature infants was 25 %. The onset of symptom was 4.7 weeks of age in premature, and 2.9 weeks in full-term babies. Diagnosis was established by typical symptoms. signs. and diagnostic imaging studies. In two premature infants, diagnosis was confirmed by upper gastrointestinal(GI) series, because ultrasonography did not meet the diagnostic criteria. Two premature infants initially diagnosed as gastroesophageal reflux by esophagography. were found to have IHPS by upper GI series. For the diagnosis of IHPS, a new set of criteria for premature babies has to be developed.

Infantile hypertrophic pyloric stenosis is one of the most common disorders requiring surgical therapy during the first few weeks of life. Although the pyloromyotomy, reported by Fredet and Ramstedt, was accepted as a standard procedure of choice, various laparotomy incisions have been reported by several authors. Currently, the most commonly used transverse or right upper quadrant incisions, offer many advantages, but is not without drawbacks. The authors utilized the circumumbilical skin incision and upper subcutaneous dissection followed by vertical division of linea alba in 16 cases of infantile hypertrophic pyloric stenosis. This incision avoids transection of rectus muscle and offers a much better cosmetic result. We prefer this procedure because of acceptable scar and no additional wound complication.