PEDIATRICS Vol. 81 No. 2 February 1988, pp. 213-217
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Changing Patterns in the Diagnosis of Hypertrophic Pyloric Stenosis

Charles W. Breaux Jr MD1, Keith E. Georgeson MD1, Stuart A. Royal MD1, and Adrian J. Curnow MD1

1 From the Departments of Surgery and Radiology, The Children's Hospital of Alabama, and the Departments of Surgery and Radiology, The University of Alabama School of Medicine, Birmingham

The records of 216 infants who had surgical correction of hypertrophic pyloric stenosis between 1980 and 1984 at the Children's Hospital of Alabama were reviewed. A significant increase in the reliance on upper gastrointestinal roentgenographic series and abdominal sonography for confirmation of the diagnosis of hypertrophic pyloric stenosis was noted in our patients when compared to previous reports. Despite the preoperative presence of a palpable pyloric mass in 192 (89%) of the patients, 174 (81%) had a diagnostic imaging procedure. Similar high rates of imaging studies were noted when the records of patients with hypertrophic pyloric stenosis from 1980 and 1984 were reviewed at three other institutions. Palpation of a hypertrophied pylorus is diagnostic of hypertrophic pyloric stenosis. Careful physical examination makes diagnostic imaging unnecessary in the majority of infants with symptoms suggesting hypertrophic pyloric stenosis. Diagnostic imaging for suspected hypertrophic pyloric stenosis should be used only for those infants with persistent vomiting in whom careful and repeated physical examinations fail to detect a palpable pyloric mass.

Key Words: hypertrophic pyloric stenosis • upper gastrointestinal roentgenographic series • abdominal sonography

Submitted on December 1, 1986
Accepted on February 20, 1987




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