Sonography and color Doppler sonography for monitoring conservatively treated infantile hypertrophic pyloric stenosis

Objective. To evaluate the role of sonography in infants with hypertrophic pyloric stenosis undergoing conservative medical treatment. Methods. Twenty -two infants (17 male and 5 female; age range, 1-12 weeks) were clinically and sonographically considered suitable for conservative treatment and unde rwent follow-up during the course of the disease. Sonography was performed under a standardized protocol and included color Doppler sonography. Result s. Fifteen infants (mean age, 9 weeks) needed surgery. They Initially had a mean pyloric length of 18 mm, a diameter of 10.5 mm, and-a wall thickness of 4 mm, with visible passage of food into the duodenum. These values deter iorated during follow-up (mean preoperative values: length, 20 mm; diameter , 12 mm; and wall thickness, 4.5 mm); furthermore, passage of food through the pyloric canal ceased. Seven infants (mean age, 3 weeks) were successful ly treated conservatively. Their initial mean pyloric measurements were sli ghtly smaller (length, 15 mm; diameter, 10 mm; and wall thickness, 3.8 mm) and did not deteriorate during follow-up. In all of them, sonography showed improvement of passage through the pyloric canal within several days, as s hown and documented by color Doppler sonography; morphologic changes pers t ed longer despite clinical improvement. Conclusions. Sonography. including color Doppler sonography, is a valuable tool for monitoring infants with hy pertrophic pyloric stenosis undergoing conservative treatment; however, ini tial sonograms cannot predict the further course of the disease.