Presentation
Persistent projectile non-bilious vomiting for 2 days. On examination, the baby was mildly dehydrated and a palpable mass was noted at the epigastric region.
Patient Data
Ultrasound was done for the baby after 4-hour fasting and then feeding on the table. It showed a distended stomach with delayed gastric evacuation. Elongated pyloric canal measures about 16 mm in length with increased pyloric muscle thickness measures about 6 mm, which is diagnostic for infantile hypertrophic pyloric stenosis.
Case Discussion
The diagnosis was confirmed by surgery and pyloromyotomy was done. Ultrasound (US) is the diagnostic test of choice as a non-invasive modality.
Infantile hypertrophic pyloric stenosis (IHPS) is the most common infantile condition that requires surgical intervention in the first few months of their life. It is featured by thickening of the pyloric canal muscle layer and failure relaxation of the pyloric canal which leads to gastric outlet obstruction. Also, increased length of the pyloric canal more than 12 mm and mucosal thickening 1.
The main diagnostic ultrasound feature is the thickness of the muscular layer. An abnormal cut off value of 3 mm in thickness has been described in the literature 1.