Hypertrophic pyloric stenosis: Sonographic monitoring of conservative therapy with intravenous atropine sulfate.

Aim: Ultrasound is the method of choice for the diagnosis of hypertrophic p yloric stenosis (HPS). The purpose of this study was to evaluate the useful ness of sonography in monitoring the efficacy of conservative therapy of HP S with intravenous atropine sulfate. Method: 21 infants with HPS under i.v. treatment with atropine sulfate were included. Pyloric sonomorphology, cha nnel width and passage of gastric contents through the pyloric channel were monitored daily. The latter was examined with colour Doppler, too. If no c linical improvement was observed after 6-8 days, sonography and colour Dopp ler sonography played a crucial role in the decision whether to continue th e conservative therapy or to perform pyloromyotomy. Results: Conservative t reatment was effective in 13/21 infants. In 8 patients therapy was continue d as sonography demonstrated the passage of gastric contents despite lack o f clinical improvement. In 4 patients, due to the sonographic findings, imp ending surgery could be cancelled. Colour Doppler sonography proved to be e xtremely useful in demonstrating passage of liquid through the narrowed pyl oric channel. No significant change in pyloric morphology was seen. Conclus ion: In HPS a conservative therapeutic approach with atropine sulfate is Ju stified considering a success rate of 62% (13/21). During sonographic monit oring the detection of the passing of gastric content may be crucial for co ntinuation and success of conservative therapy. In those cases colour Doppl er sonography is a very useful method.