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Ultrasonographic Diagnosis of Congenital Hypertrophic Pyloric Stenosis.

Journal of the Korean Pediatric Society 1989;32(6):756-764.
Published online June 30, 1989.
Ultrasonographic Diagnosis of Congenital Hypertrophic Pyloric Stenosis.
Shin Heh Kang1, Chul Lee1, Ran Namgung1, Dong Gwan Han1, Ki Keun Oh2, Seung Hun Choi3
1Department of Pediatrics, College of Medicine, Yonsei University Seoul, Korea
2Department of Radiology , College of Medicine, Yonsei University Seoul, Korea
3Department of Surgery, College of Medicine, Yonsei University Seoul, Korea
선천성 비후성 유문 협착증에서의 초음파 진단의 의의
강신혜1, 이철1, 남궁란1, 한동관1, 오기근2, 최승훈3
1연세의대 의과대학 소아과학교실
2연세의대 의과대학 방사선과학교실
3연세의대 의과대학 외과학교실
Received: 25 November 1988   • Accepted: 25 November 1988
The diagnosis of congenital hypertrophic pyloric stenosis has traditionally been made on the basis of history and physical examination in the majority of patients. Imaging procedures such as UGI series have been reserved for vomiting infats in whom the diagnosis was obscure. More recently ultrasonography with the lack of hazards associated with radiation provides an additional method of investigation which is accurate and diagnose some cases in which no pyloric mass is palpable. Real time sonogram was performed in 20 infants with nonbile stained projectile vomiting who was admitted to Yongdong Severance Hospital from Jamuary 1987 thru October 1988. Each imaged infant had determinations of three parameters: pyloric muscle thickness, pyloric diameter and pyloric length . Those who were diagnosed as CHPS by ultrasound underwent surgery. During pyloromyotomy the pylorus was precisely measured concerning muscle thickness, pyloric diameter and pyloric length. The preoperative sonographic and intraoperative measurements were subsequently compared. We undertook the present study to evaluate the diagnostic value and accuracy of ultrasonogram in CHPS. The results are as follows; 1) According to the ultrasonic examination, 16 cases were diagnosed as CHPS and all was confirmed by surgery. Non CHPS 4 cases with negative findings on ultrasound had subsequent confirmation of diagnosis as pyloric spasm 2 cases and gastroesophageal reflux 2 cases by UGI series and esophagogram. 2) In the infants with CHPS, muscle thickness was 5.03±0.99 mm, pyloric diameter 15.69±2.72 mm, pyloric length 21.24±4.62 mm which was significantly larger than the infants who did not have pyloric stenosis (p<0.001). 3) The operative measurements of muscle thickness was 5.29±1.03 mm, pyloric diameter 16.31± 2. 39 mm, pyloric length 24.44±4.03 mm which showed no difference between preoperative ultrasonic measurements. 4) The distribution of ultrasonic pyloric diameter measurements showed overlap between the infants with and without CHPS. But there was complete separation of 2 groups according to pyloric muscle thickness and pyloric length. We consider pyloric muscle thickness greater than 4 mm and pyloric length greater than 15 mm are useful parameters for diagnosis of CHPS. We conclude that real time ultrasonic determination of pyloric stenosis is accurate, rapid and safe allowing earlier diagnosis of CHPS. It should replace the barium study in the evaluation of CHPS where the clinical diagnosis is in doubt.
Key Words: Congenital hypertrophic pyloric stenosis, UJtrasonography

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