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Infantile Hypertrophic Pyloric Stenosis

#TIME TO REFORM THE COUNSELLING #

IHPSInfantile Hypertrophic Pyloric stenosis is the most common cause of gastric outlet obstruction in infants with incidence 3 per 1000 live birth and Male preponderance M: F 3:1 commonly affecting 1st born male child around 2 to 4 weeks of life with recurrent non bilious Projectile vomiting.

PRESENTATION

  • Projectile non bilious vomiting
  • Dehydration (variable degrees)
  • Lethargic child
  • Seizures ( DUE to Dyselectrolytemia)
  • Constipation
  • Failure to thrive in neglected and undiagnosed cases which may cost life

SIGNS

  • DEHYDRATION due to recurrent vomiting
  • VISIBLE GASTRIC PERISTALSIS
  • PALPABLE PYLORIC MASS IN TRAINED HANDS
  • SHOCK AND SEIZURES

"A good clinical examination is fair enough for the Diagnosis."
Still in present Era of DIAGNOSTICS.
Only 1 investigation is required for confirmation which is GOLD STANDARD : ULTRASOUND WHOLE ABDOMEN.

IHPS needs proper optimization of the baby prior to surgery as major risk to life is dyselectrolytemia. Correction of dehydration and acid base imbalance takes precedence for best surgical outcome. Improper management can be detrimental to life.

INDEX CASE

60 days female baby ( UNCOMMON GENDER LATE PRESENTER) presented with complaint of multiple episodes of non- bilious vomiting, progressive in nature soon after feed for past 15 days. Child was irritable with signs of mild dehydration with visible GASTRIC PERISTALSIS AND PALPABLE PYLORIC MASS(OLIVE) Ultrasound whole abdomen confirmed the diagnosis.

TREATMENT PYLOROMYOTOMY

  • OPEN RAMSTEDT Pyloromyotomy
  • LAPAROSCOPIC PYLOROMYOTOMY

After optimization the baby was taken for Laparoscopic Pyloromyotomy.

APPLICATION OF LAPROSCOPY IN IHPS came late in comparison to other Pediatric Laproscopic procedures in view of adequate justification regarding safety and adequacy for newborn babies.

There are technical challenges in pursuing laparoscopy in very small babies. The procedure went satisfactory and baby extubated well post procedure. Feeding resumed a day after and is being discharged on full feed over a total hospital stay of 3 days. Gratitude to almighty and everyone

# Laparoscopic Pyloromyotomy # Minimal Invasive Surgery # Keyhole Surgery# Newborn Laproscopy