PYLORIC-STENOSIS - IS OVER-RELIANCE ON ULTRASOUND SCANS LEADING TO NEGATIVE EXPLORATIONS

Aim: To see whether increasing use of ultrasound scans in pyloric sten osis is leading to false-positive diagnoses, and even negative laparot omies. Methods: Over a 2-year period, 76 neonates underwent laparotomy with a preoperative diagnosis of pyloric stenosis (PS). There were 57 males and 19 females, age ranged from 10 days to 7 weeks. Results: Si x patients proceeded straight to surgery after undergoing a test feed. The remaining 70 patients had one or more imaging investigations, Of there; 56 patients had an ultrasound only, 5 had a barium meal only wh ile 9 patients had both investigations. Ultrasound showed evolving les ions in 2 patients, It was equivocal or falsely negative in 8 - all we re diagnosed correctly after undergoing barium meals, Fifty-two patien ts were diagnosed correctly on ultrasound. There were, however, 3 fals e-positive ultrasonic diagnosis - i.e., at laparotomy the pylorus was found to be normal, One of these patients even had a ''diagnostic'' ba rium meal, The factors leading to these negative explorations are disc ussed, Conclusion: Pyloric ''tumours'' can be difficult to palpate ear ly in the evolution of the disease, Reliance upon the ultrasound appea rance of the pylorus without taking into account other important diagn ostic evidence will increase the risk of false-positive diagnoses and unnecessary laparotomy, The importance of clinical examination and tes t feed is emphasised.