Ea. Chen et al., PYLORIC-STENOSIS IN THE AGE OF ULTRASONOGRAPHY - FADING SKILLS, BETTER PATIENTS, Journal of pediatric surgery, 31(6), 1996, pp. 829-830
Hypertrophic pyloric stenosis can be diagnosed accurately by physical
examination alone. However, ultrasonographic confirmation is obtained
in the majority of cases, often before clinical evaluation by the surg
eon. The present study examines whether the easy access to ultrasonogr
aphy by the primary physician has affected the care of infants with py
loric stenosis. During a 24-month period, 100 infants were treated for
pyloric stenosis at the authors' institution. There were 78 boys and
22 girls; the age range was 9 to 90 days (median, 30.0 days). The chil
dren were referred for surgical evaluation, but abdominal ultrasonogra
phy was ordered concomitantly (or within 1 hour of surgical consultati
on) in all cases. The median age at the onset of the first symptoms wa
s 24.0 days. The time between onset and hospital admission was less th
an 7 days for 72 patients, and more than 2 weeks for seven. Metabolic
alkalosis or acidosis, hypokalemia, hypochloremia, and dehydration wer
e noted in 10%, 5%, 3% and 9%, respectively. Six infants had prolonged
pre- and postoperative courses, because of prematurity (4) or associa
ted conditions (2). For the remaining patients, total hospitalization
period and postoperative stay were 3.8 +/- 0.9 days and 2.8 +/- 0.6 da
ys, respectively. Although the diminished importance of clinical skill
s in the diagnosis of pyloric stenosis may be regrettable, the availab
ility to the primary care physician of this easy, safe, inexpensive, a
nd reliable imaging modality may contribute to prompter treatment. The
pa patients were hospitalized, with a correct diagnosis, within days
of the appearance of the initial symptoms. Because so little time had
elapsed, water and electrolyte imbalances were not present, and the pa
tients could be operated on within hours of admission. Copyright (C) 1
996 by W.B. Saunders Company