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Clinical Evaluation of Ultrasonographic Findings in Congenital Hypertrophic Pyloric Stenosis.

Journal of the Korean Pediatric Society 1986;29(9):954-963.
Published online September 30, 1986.
Clinical Evaluation of Ultrasonographic Findings in Congenital Hypertrophic Pyloric Stenosis.
Gyu Ho Lim, Young Bin Cho, Young Choon Woo, Ki Yang Ryoo
Department of Pediatrics, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea
선천성 비후성 유문협착증의 임상적 고찰과 초음파진단의 의의
임규호, 조영빈, 우영춘, 유기양
한립의대 부속 강남성심병원 소아과
Congenital hypertrophic pyloric stenosis is the most common intraabdominal condition requiring surgery during the first few months of life. In many cases the diagnosis can be made clinically by a history of projetile vomiting, and by palpation of a pyloric tumor. Barium study is considered necessary if the diagnosis can not be established with certainty on physical sign alone. We report 11 cases in which hypertrophic pyloric stenosis was diagnosed preoperatively with ultrasonography and suggest this might be an alternate method in reaching a diagnosis in cases where the classic sign are not obvious. Together with a ultrasonographic study, a clinical study was carried out from January 1984 to September 1985. The results were as follows: 1) The age distribution on admission was highest between 2 to 8 weeks of age, and male to female ratio was 8:3. 5 cases were first born. 2) In a percentile of body weight on admission, 8 cases were underdeveloped (10 percentile or less) and 5 cases were breast-fed. 3) The age at onset of symptom was highest between 2 to 3 weeks of age in majorities cases(45.4%). 4) Nori-bile stained vomiting was noted in all cases and coffee ground vomitus was noted. 5) On physical examintion, nontender and hard mass in right upper quadrant was palpated in 6 cases(54.5%) and gastric peristaltic wave was observed in 6 cases (54.5%), also varying degree of dehydration was noted in all cases. 6) UGI series showed the classic “string sign” in 10 cases. 7) In the real time ultrasonographic study, the characteristic “true target sign” of congenital hypertrophic pyloric stenosis was demonstrated in all cases. Each diameter of targets measured 1.5 cm or more, and each side of the hypoechoic ring measured 4 cm or more in it’s thickness of the true target sign. 10) All cases were surgically treated with Fredt-Ramstedt procedure and discharged, without any complications.
Key Words: Congenital hypertrophic pyloric stenosis, Clinical evaluation, Ultrasound.

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