The collected clinical data of 68 patients of infantile hypertrophic pyloric stenosis treated surgically at the Department of Surgery, Chonbuk National University Hospital during the period of 11 years from January, 1982 to December, 1992 have
been
analysed on various clinical aspects.
The ratio of male to female was 6.6:1 and 51.1% of the patients was first-born baby.
Formula-fed infants were most often affected as 48.5% compared to breast-fed(23.5%), and breast and formula-fed ones(28.0%), but there was no significant difference statistically.
The onset of the symptoms was occurred most frequently between 2 and 4 weeks of age(32.4%) and average onset occurred at twenty first day after birth, and the mean duration of symptoms was 16 days.
The main symptoms were nonbilious projectile vomiting(100.0%), constipation(86.8%) and decreased frequency of urination(83.8%), and blood-stained vomitus was also observed in 5 cases (7.4%).
The main physical findings were variable extents of weight loss(1000.0%), visible gastric peristalsis(86.8%), palpable mass on right upper quadrant abdomen(76.5%), signs of dehydration (691%) and jaundice(22.1%)
All the patients were scored average 6.4±10.15th percentile of growth and development.
The characteristic findings on upper gastrointestinal contrast study(63 cases) and ultrasonography 95 cases) were shown in all of the patients.
The associated disease was detected in 14 cases(20.6%) and they were atrial and/or ventricular septal defect(5 cases), inguinal hernia(4 case), neonatal hepatitis(2 cases) and others in order of frequency.
On labolatory data at the time of admission anemia below 11.2gm/dl of hemoglobin was observed in 33.8% of all patients, hypoproteinemia below 5.5gm/dl in 38.5% of 52 patients and hyperbilirubinemia above 1.0mg/dl in 76.9% of 52 patients.
Hypochloremia
below 98 mEq/L. was observed in 40.0%, hypokalemia below 3.5 mEq/L. in 27.9% and hypochloremic hypokalemic alkalosis in 31.7% of 60 patients. pH above 7.43 was oberved in 97.8%, base excess above 3mmol/L. in 60.0% and CO2 content above 30mmol/L.
in
53.3% of 45 patient on arterial blood gas analysis. There was a tendency to decrease the laboratory values of hemoglobin, total serum protein and K+ against the duration of illness and to decrease the laboratory values of pH, base excess and CO2
content
with the duration of illness but there was no statistical significancy.
Average 45.6 hours were required for preoperative treatment. On preoperative serum electrolyte measurement and arterial blood gas analysis, average values of C-, K+, pH, base excess and CO2 content were 101.3±6.3mEq/L., 4.05±0.59mEq/L,
7.52±0.06,
4.9±4.35mmol/L. and 28.4±4.82mmol/L. respectively.
Rammstedt's pyloromyotomy was perforemd in all of the patients. Duodenal perforation was developed in 3 cases(4.4%) during the operation and they were treated by simple closure with omentopexy and Rammstedt procedure was carried on at
45°-rotated
site
from the first pyloric incision.
The postoperative vomiting was developed in 24 cases(35.3%), and was disappeared within 6 days by conservative treatment in all of the patients.
The postoperative complicating were developed in 3 cases(4.4%), and they were incisional hernia(1 case), stress ulcer bleeding(1 case) and prolonged paralytic ileus(1 case)
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