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Delayed Infantile Hypertrophic Pyloric Stenosis: Age Distribution by Ultrasonography Parameters

Year 2020, Volume: 17 Issue: 2, 223 - 227, 20.08.2020
https://doi.org/10.35440/hutfd.733290

Abstract

Background: In this study, it was aimed to evaluate the correlation of ultrasonography (USG) parameters (pyloric muscle sizes) with age in term infants diagnosed with infantile hypertrophic pyloric stenosis (IHPS).
Materials and Methods: Data of 49 patients diagnosed with IHPS between November 2015 and December 2019 and underwent pyloromyotomy surgery were retrospectively analyzed for this study. The demographic and laboratory data were obtained from the electronic records of the patients. USG parameters such as pyloric muscle thickness (PMT), pyloric diameter (PD), and pyloric muscle length (PML) were measured separately. Term infants were divided into two groups as neonatal (0-28 days) and postneonatal (29-364 days) in order to compare the distribution of USG parameters by age. Infants whose clinical data and USG images were not available together with preterm infants (gestational age <37 weeks) were excluded from the study.
Results: Of the 32 patients included in the study, 24 (75%) were male and 8 (25%) were female, and the mean age of the infants was 57.8 days and the median (minimum-maximum) value was 57.5 (9-180) days at the time of admission. In USG examinations, the hypertrophic pyloric muscle was detected in elongated and thick appearance, narrowing the lumen in all patients. There were 15 (46.9%) infants in the neonatal period and 17 (53.1%) in the postneonatal period. In the preoperative measurements, PMT, PD, and PML were high (median value; 4.8, 11.2 and 19.5 mm, respectively). The pyloric measurements of infants in the neonatal and postneonatal period were similar between the two groups, and there was no statistically significant difference (p> 0.05). The correlation between PMT and PML (r = 0.490, p = 0.033) and the correlation between PMT and PD (r = 0.741, p < 0.001) were significant. However, no significant correlation was found between age and pyloric measurements (p> 0.05). When comparing laboratory data, hemoglobin values were significantly lower in infants in the postneonatal period compared to the neonatal group (11±1.5 and 13.7±2.7 g/dL; p < 0.001, respectively).
Conclusion: Due to the advantages of USG ionizing radiation used in the diagnosis of IHPS, high sensitivity, and dynamic examination, it is an effective and reliable imaging method that should be preferred first. Although pyloric measurements are valuable for diagnosis, it has been concluded that there is no significant correlation between age and pyloric sizes.

References

  • 1. Ndongo R, Tolefac PN, Tambo FFM, Abanda MH, Ngowe MN, Fola O, et al. Infantile hypertrophic pyloric stenosis: A 4-year experience from two tertiary care centres in Cameroon. BMC Res Notes [Internet]. 2018;11(1):18–22. Available from: https://doi.org/10.1186/s13104-018-3131-1 2. Godbole P, Sprigg A, Dickson JAS, Lin PC. Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis. Arch Dis Child. 1996;75(4):335–7. 3. Forster N, Haddad RL, Choroomi S, Dilley A V., Pereira J. Use of ultrasound in 187 infants with suspected infantile hypertrophic pyloric stenosis. Australas Radiol. 2007;51(6):560–3. 4. Tashiro A, Yoshida H, Okamoto E. Infant, neonatal, and postneonatal mortality trends in a disaster region and in Japan, 2002-2012: A multi-attribute compositional study. BMC Public Health. 2019;19(1):1–13. 5. Ayaz ÜY, Döğen ME, Dilli A, Ayaz S, Api A. The use of ultrasonography in infantile hypertrophic pyloric stenosis: Do the patient’s age and weight affect pyloric size and pyloric ratio? Med Ultrason. 2015;17(1):28–33. 6. Alehossein M, Hedayat F, Salamati P, Khavari HA, Mollaeian M. The validity of ultrasound in diagnosing hypertrophic pyloric stenosis. Pakistan J Med Sci. 2009;25(1):65–8. 7. Raveenthiran V. ATHENA’S PAGES Centennial of Pyloromyotomy. J Neonatal Surg [Internet]. 2013;2(1). Available from: http://www.elmedpub.com 8. Costa Dias S, Swinson S, Torrão H, Gonçalves L, Kurochka S, Vaz CP, et al. Hypertrophic pyloric stenosis: Tips and tricks for ultrasound diagnosis. Insights Imaging. 2012;3(3):247–50. 9. Blumhagen D, George H, Noble S. Muscle thickness in hypertrophic pyloric stenosis: sonographic determination. AJR Am J Roentgenol. 1983;140:221–3. 10. Riccabona M, Weitzer C, Lindbichler F, Mayr J. Sonography and color Doppler sonography for monitoring conservatively treated infantile hypertrophic pyloric stenosis. J Ultrasound Med [Internet]. 2001 Sep;20(9):997–1002. Available from: http://doi.wiley.com/10.7863/jum.2001.20.9.997 11. Leaphart CL, Borland K, Kane TD, Hackam DJ. Hypertrophic pyloric stenosis in newborns younger than 21 days: remodeling the path of surgical intervention. J Pediatr Surg [Internet]. 2008 Jun;43(6):998–1001. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022346808001589 12. Touloukian RJ, Higgins E. The spectrum of serum electrolytes in hypertrophic pyloric stenosis. J Pediatr Surg. 1983;18(4):394–7.

Gecikmiş İnfantil Hipertrofik Pilor Stenozu: Ultrasonografi Parametrelerinin Yaşa Göre Dağılımı

Year 2020, Volume: 17 Issue: 2, 223 - 227, 20.08.2020
https://doi.org/10.35440/hutfd.733290

Abstract

Amaç: Bu çalışmada, infantil hipertrofik pilor stenozu (İHPS) tanılı term infantlarda ultrasonografi (USG) parametrelerinin (pilor kası boyutları) yaş ile korelasyonunun değerlendirilmesi amaçlandı.
Materyal ve metod: Kasım 2015 ve Aralık 2019 tarihleri arasında, İHPS tanısı alıp piloromiyotomi ameliyatı yapılan 49 hastanın verileri retrospektif olarak analiz edildi. Hastaların demografik ve laboratuvar verileri elektronik medikal kayıtlarından elde edildi. Pilor kas kalınlığı (PK), pilor çapı (PÇ) ve pilor kas uzunluğu (PU) gibi USG parametreleri ayrı ayrı ölçüldü. Pilorik ölçümlerin yaşa göre dağılımını değerlendirmek amacıyla term infantlar neonatal (0 - 28 gün) ve postneonatal (29 - 364 gün) olmak üzere iki gruba ayrıldı. Preterm infantlar (gebelik yaşı <37 hafta) ile birlikte klinik verilerine ve ultrasonografi görüntülerine ulaşılamayan infantlar çalışma dışı bırakıldı.
Bulgular: Çalışmaya dahil edilen 32 hastanın 24 (%75)’ ü erkek ve 8 (%25)’i kız olup, başvuru anında infantların ortalama yaşı 57.8 ve median (minimum-maksimum) değeri 57.5 (9-180) gün idi. Tüm hastalarda lümeni daraltan, elonge ve kalın görünümde hipertrofik pilor kası tespit edildi. Tüm vakalarda distandü midede peristaltizm artışı ve mide içeriğinin duodenuma geçişinin olmaması veya yavaşlaması mevcuttu. Neonatal dönemde 15 (%46.9) ve postneonatal dönemde 17 (%53.1) infant mevcuttu. Ameliyat öncesi hastalara yapılan ölçümlerde PK, PÇ ve PU yüksekti (median değer sırasıyla; 4.8, 11.2 ve 19.5 mm). Neonatal ve postneonatal dönemdeki infantların pilorik ölçümleri her iki grup arasında benzer olup istatistiksel olarak anlamlı farklılık saptanmadı (p > 0.05). Yapılan korelasyon analizinde PK ile PU (r = 0.490, p = 0.033) ve PK ile PÇ arasında (r = 0.741, p < 0.001) anlamlı oranda pozitif korelasyon mevcuttu. Ancak yaş ile pilorik ölçümler arasında anlamlı korelasyon saptanmadı (p > 0.05). Laboratuvar verileri açısından karşılaştırma yapıldığında postneonatal dönemdeki infantlarda neonatal gruba göre hemoglobin değerleri anlamlı olarak düşük bulundu (sırasıyla 11±1.5 ve 13.7±2.7; p < 0.001).
Sonuç: İHPS tanısında kullanılan USG iyonizan radyasyon içermemesi, yüksek duyarlılığı ve dinamik inceleme yapılabilmesi gibi avantajları nedeniyle, ilk tercih edilmesi gereken etkili ve güvenilir bir görüntüleme yöntemidir. Pilor kas ölçümleri tanı için değerli olmakla birlikte yaş ve kas boyutları arasında anlamlı korelasyon olmadığı sonucuna varıldı. 

References

  • 1. Ndongo R, Tolefac PN, Tambo FFM, Abanda MH, Ngowe MN, Fola O, et al. Infantile hypertrophic pyloric stenosis: A 4-year experience from two tertiary care centres in Cameroon. BMC Res Notes [Internet]. 2018;11(1):18–22. Available from: https://doi.org/10.1186/s13104-018-3131-1 2. Godbole P, Sprigg A, Dickson JAS, Lin PC. Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis. Arch Dis Child. 1996;75(4):335–7. 3. Forster N, Haddad RL, Choroomi S, Dilley A V., Pereira J. Use of ultrasound in 187 infants with suspected infantile hypertrophic pyloric stenosis. Australas Radiol. 2007;51(6):560–3. 4. Tashiro A, Yoshida H, Okamoto E. Infant, neonatal, and postneonatal mortality trends in a disaster region and in Japan, 2002-2012: A multi-attribute compositional study. BMC Public Health. 2019;19(1):1–13. 5. Ayaz ÜY, Döğen ME, Dilli A, Ayaz S, Api A. The use of ultrasonography in infantile hypertrophic pyloric stenosis: Do the patient’s age and weight affect pyloric size and pyloric ratio? Med Ultrason. 2015;17(1):28–33. 6. Alehossein M, Hedayat F, Salamati P, Khavari HA, Mollaeian M. The validity of ultrasound in diagnosing hypertrophic pyloric stenosis. Pakistan J Med Sci. 2009;25(1):65–8. 7. Raveenthiran V. ATHENA’S PAGES Centennial of Pyloromyotomy. J Neonatal Surg [Internet]. 2013;2(1). Available from: http://www.elmedpub.com 8. Costa Dias S, Swinson S, Torrão H, Gonçalves L, Kurochka S, Vaz CP, et al. Hypertrophic pyloric stenosis: Tips and tricks for ultrasound diagnosis. Insights Imaging. 2012;3(3):247–50. 9. Blumhagen D, George H, Noble S. Muscle thickness in hypertrophic pyloric stenosis: sonographic determination. AJR Am J Roentgenol. 1983;140:221–3. 10. Riccabona M, Weitzer C, Lindbichler F, Mayr J. Sonography and color Doppler sonography for monitoring conservatively treated infantile hypertrophic pyloric stenosis. J Ultrasound Med [Internet]. 2001 Sep;20(9):997–1002. Available from: http://doi.wiley.com/10.7863/jum.2001.20.9.997 11. Leaphart CL, Borland K, Kane TD, Hackam DJ. Hypertrophic pyloric stenosis in newborns younger than 21 days: remodeling the path of surgical intervention. J Pediatr Surg [Internet]. 2008 Jun;43(6):998–1001. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022346808001589 12. Touloukian RJ, Higgins E. The spectrum of serum electrolytes in hypertrophic pyloric stenosis. J Pediatr Surg. 1983;18(4):394–7.
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Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Mehmet Tahtabaşı 0000-0001-9668-8062

Mehmet Kolu 0000-0001-9659-6053

Mustafa Erman Dörterler 0000-0001-9304-6830

Publication Date August 20, 2020
Submission Date May 6, 2020
Acceptance Date July 6, 2020
Published in Issue Year 2020 Volume: 17 Issue: 2

Cite

Vancouver Tahtabaşı M, Kolu M, Dörterler ME. Gecikmiş İnfantil Hipertrofik Pilor Stenozu: Ultrasonografi Parametrelerinin Yaşa Göre Dağılımı. Harran Üniversitesi Tıp Fakültesi Dergisi. 2020;17(2):223-7.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty