All issues > Volume 32(6); 1989

Original Article

J Korean Pediatr Soc. 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

Received: November 25, 1988;  Accepted: November 25, 1988.

Abstract

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.

Keywords :Congenital hypertrophic pyloric stenosis, UJtrasonography