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KMID : 0616619990050010091
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Journal of Soonchunhyang Medical College
1999 Volume.5 No. 1 p.91 ~ p.97
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A Clinical Study on the Factors Affecting the Pyloric Thickness in Infantile Hypertrophic Pyloric Stenosis
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Abstract
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The infantile hypertropic pyloric stenosis is the most common surgical condition during period of one to three months after birth, and is diagnosed without difficulty by symptoms of projectile nonbilious vomiting, visible gastric waves and palpation of olive shaped mass and confirmed by upper G-I series and abdominal ultrasonogram if symptoms were not diagnostic. It´s treatment performing Fredet-Ramstedt pyloromyotomy is relatively easy. But, considering some serious complications such as dehydration, electrolyte imbalance, malnutrition, persistence of symptoms, duodenal perforation and hemorrhage developing during or after operation, it is necessary to study the size of the pyloric muscle and relating clinical factors for secure and safe pyloromyotomy.
The purpose of this study is to assess the affecting factors associated with thickness and length of pyloric muscle in infantile hypertrophic pyloric stenosis.
60 cases of infantile hypertrophic pyloric stenosis had analysed, who had been treated with pyloromyotomy from November 1993 to December 1997 in Mok-dong Hospital, Ewha Womans Medical College. The results were as follows;
(1) By ultrasonographic measurement, the thickness and length of pylorus were 5.7±1.6mm(ranges 3.5 ∼ 10mm)and 18.9±3.4mm(ranges 14 ∼ 30mm). These values were greater than normal control group of acute gastroenteritis. The thickness and length of pylorus in infant with acute gastroenteritis were 3.4±0.5mm and 7±0.4mm respectively.
(2) Major symptoms were non-bilous vomiting and olive shaped mass. In those with major symptoms of non-bilious vomitng and olive shaped mass, the thickness and length of pylorus were consistent with the mean value of entire group of patients. In those cases with symptoms of only simple nausea and vomiting, the thickness and length of pyloric muscle were smaller than mean value of entire group. But, in cases with symptoms of jaundice, the thickness and length were greater than the mean value of entire group.
(3) In cases with symptom duration for 1 week, the thickness and length of pyloric muscle were less than the mean value of the group of 2 weeks duration. But, there was no significant difference between groups of 2 weeks and 3 weeks of symptom duration.
(4) Heavier the body weight at the same age, the larger the thickness and length of pylorus.
(5) In cases with breast feeding, the thickness of pyloric muscle was greater than that of milk feeding group or mixed feeding group. But there was no difference in the length of pyloric muscle between types of feeding.
(6) Electrolyte imbalance were hypochloremia, hypokalemia and metabolic alkalosis. In patients with hypokalemia less than 3.2mEq/L, there was significant increase in the thickness and length of pyloric muscle. But there was no difference in thickness and length of pyloric muscle according to the level of serum chloride.
(7) With the group of positive IgG of H.pylori by ELISA test, the thickness and length of pyloric muscle were significantly larger than that of negative group.
From these results, it may be concluded that the thickness and length of pyloric muscle were affected by following factors; pattern of cardinal symptoms of nonbilious vomiting and olive sized mass, symptom duration of more than 2weeks, heavier body weight, breast feeding, hypokalemia and presence of H.pylori infection.
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