PYLORIC-STENOSIS IN THE AGE OF ULTRASONOGRAPHY - FADING SKILLS, BETTER PATIENTS

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