EVOLUTION IN THE RECOGNITION OF INFANTILE HYPERTROPHIC PYLORIC-STENOSIS

Purpose. To analyze changes in the clinical condition at presentation and methods of establishing the diagnosis of infantile hypertrophic py loric stenosis (IHPS). Methods. Retrospective review of patients who u nderwent pyloromyotomy (PM) for suspected IHPS at two institutions fro m 1969 through 1994 was performed. For the purposes of comparison, the population was divided into five equal time periods. Results. Over th e 25-year period, 901 infants underwent PM. Patients presented at a yo unger age, weighed more, and had a shorter length of illness in the mo st recent time period. Hypochloremic alkalosis was found half as frequ ently in the most recent time period compared to the earliest group. A palpable pyloric tumor was present in 79% of patients in the earliest time period compared with 23% in the mast recent time period. Sixty-o ne percent of patients in the earliest group and 96% in the latest gro up underwent an imaging study, reflecting the referring physician's ev aluation before referral to the surgeon. Conclusions. Currently, patie nts with IHPS less frequently present with the clinical hallmarks of t he disease. The use of imaging studies to establish the diagnosis has become common practice. The result has been the diagnosis of IHPS befo re alkalosis has developed, a shorter clinical course, less morbidity, and a shorter postoperative hospital stay.