Ultrasound as a diagnostic tool used by surgeons in pyloric stenosis

The purpose of the study was to validate surgeon-performed abdominal ultrasound in the diagnosis of pyloric stenosis, thus expediting diagnosis and management and increasing overall cost-effectiveness.

A surgical resident, after completing ultrasound courses offered by the American College of Surgeons, Chicago, IL, examined 30 consecutive patients with a suspected diagnosis of hypertrophic pyloric stenosis (HPS). Blinded regarding both clinical and radiographic findings, the resident scanned the pylorus in longitudinal and transverse axes. Positive ultrasonographic evidence of HPS was defined as muscle thickness of at least 4 mm and/or channel length of at least 16 mm. Surgeon and radiology measurements were compared using descriptive analyses and Student t test.

There were 25 boys and 5 girls examined. Twenty-eight of 30 patients were found to have HPS. When ultrasound performed by the surgeon was compared with that of radiology, no false-negative or false-positive results were noted. The surgeon was diagnostically accurate in all cases, and there was no statistically significant difference between surgeon and radiology measurements with regard to pyloric muscle thickness (P = .825, mean deviation = 0.4 mm) or channel length (P = .74, mean deviation = 2.2 mm).

A surgeon with appropriate training in abdominal ultrasound can diagnose HPS with the same degree of accuracy as radiologists.