Infantile hypertrophic pyloric stenosis

Abstract

Introduction: The pyloric muscle is a sphincter defining the transition between the stomach and duodenum, it control the outflow from the stomach preventing passage of large pieces of food to the duodenum, and to prevent backflow of intestinal content to the stomach. Infantile hypertrophic pyloric stenosis (IHPS) is familiar to most pediatric and general practitioners. There is hypertrophy and hyperplasia of the antropyloric portion of the stomach, which becomes abnormally thickened, it manifests as obstruction to gastric emptying. Purpose and Objectives: Highlighting the etiology, clinical manifestation, diagnosis and surgical treatment in hypertrophic pyloric stenosis behalf of the literature and case report, comparing open versus laparoscopic procedure. Materials and methods: The project is based on 20 articles and 5 published case report regarding hypertrophic pyloric stenosis, one patient case study. Results: the etiological factor for infantile hypertrophic pyloric stenosis remain idiopathic, with new risk factor erythromycin that will bind to motilin receptors directly on smooth muscle and cause contraction of pyloric bulb in addition to other risk factor like maternal smoking, and bottle feed. Infants with IHPS are clinically normal at birth, but they develop a nonbilious forceful vomiting during the first weeks of postnatal life, which is described as "projectile", if the child remain without treatment it will cause dehydration symptoms. The clinical diagnosis hinges on palpation of the thickened pylorus "straightforward after palpation of the olive sign in lateral rectus abdomens muscle after feeding the child" and the best alternative method is ultrasound of abdomen due to little cost and effectiveness. The treatment is surgical with two main method open pyloromyotomy ramstedt procedure or laparoscopic pyloromyotomy procedure. Conclusion: The laparoscopic pyloromyotomy is more effective with less complication and faster time recovery with minimal scar tissue, the progressive is excellent normally without complication.