Bilious vomiting does not rule out infantile hypertrophic pyloric stenosis

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Mary Jane Piroutek1, Lance Brown, Andrea W Thorp

  • 1Department of Emergency Medicine, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354, USA.

Clinical Pediatrics
|December 15, 2011
PubMed

Insights

Bilious vomiting is rare in infantile hypertrophic pyloric stenosis (IHPS). This study found IHPS in only 1.4% of infants presenting with bilious emesis.

Area of Science:

  • Pediatric Surgery
  • Neonatal Gastroenterology
  • Clinical Pediatrics

Background:

  • Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of non-bilious vomiting in infants.
  • Bilious vomiting in infants typically indicates a surgical emergency, often related to intestinal obstruction.
  • The presentation of IHPS can vary, and the incidence of bilious emesis in these cases is not well-defined.

Purpose of the Study:

  • To determine the incidence of bilious vomiting in infants diagnosed with infantile hypertrophic pyloric stenosis.
  • To analyze the characteristics of infants with IHPS who present with bilious emesis.

Main Methods:

  • Retrospective review of medical records for infants diagnosed with IHPS between 2005 and 2009.
  • Inclusion criteria: infants diagnosed intraoperatively with IHPS at a level 1 pediatric emergency department.
  • Definition of bilious emesis: vomit described as "green," "containing bile," or "bilious."

Main Results:

  • 354 infants with IHPS were identified; median age was 4 weeks 6 days.
  • Bilious emesis occurred in 1.4% (5/354) of infants with IHPS.
  • Infants with bilious emesis had significantly smaller pyloric thickness measurements on ultrasound compared to those without (P = .014).

Conclusions:

  • Bilious emesis is an uncommon presenting symptom in infants with infantile hypertrophic pyloric stenosis.
  • The finding suggests that while rare, bilious emesis can occur in IHPS, potentially with specific sonographic findings.
Abstract

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