The changing presentation of pyloric stenosis

Metabolic abnormalities described in pyloric stenosis are now rare, probabl y because of prompter recognition of the disease, This report reviews the t rend in presentation over three decades. All infants treated for pyloric st enosis during three mid decade target periods were re viewed. Comparison be tween the 1975 group and the 1985 group and between the 1995 group and prev ious decades were designed to identify the impact of ultrasonography, since this modality has only been available in the last decade. Parameters inclu ded age at diagnosis and incidence of water and electrolyte imbalance as me asures of delay in presentation. Two hundred eighty three patients were rev iewed. Mean age (weeks) at presentation was 5.4 +/- 3.0 in 1975, 4.6 +/- 2. 0 in 1985, and 3.4 +/- 1.3 in 1995 (P < .05, ANOVA). Overall, 88% had no el ectrolyte anomalies on admission, There was no statistical difference in fr equency of abnormal results between the three decades. Total and postoperat ive hospitalization was significantly shorter in the recent period: in 1985 , 5.34 and 4.36 days; in 1985, 4.48 and 3.4 days; and in 1995, 3.8 and 2.8 days. These data show that pyloric stenosis is now recognized earlier than in previous decades, The availability of ultrasonography cannot solely be c redited for earlier diagnosis, since this trend was already apparent before its introduction. The "classic" metabolic derangements associated with pyl oric stenosis have been highly uncommon for the past three decades. Copyrig ht (C) 1999 by W.B. Saunders Company.