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Recurrent Infantile Hypertrophic Pyloric Stenosis in the Emergency Department: A Case Report

Adeola A Kosoko1, Diego Craik Tobar1

  • 1The University of Texas Health Sciences Center at Houston, McGovern Medical School, Houston, Texas.

Clinical Practice and Cases in Emergency Medicine
|November 25, 2022
PubMed

Insights

Recurrent infantile hypertrophic pyloric stenosis (IHPS) can occur after surgery. Ultrasound and upper GI series are key to diagnosing IHPS recurrence and guiding further pyloromyotomy treatment.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Infantile hypertrophic pyloric stenosis (IHPS) is a frequent cause of vomiting in infants.
  • Diagnosis is typically achieved via pyloric ultrasound, with surgical pyloromyotomy as the standard treatment.

Purpose of the Study:

  • To report a case of recurrent IHPS in an infant previously treated with pyloromyotomy.
  • To highlight the diagnostic utility of upper gastrointestinal series in conjunction with ultrasound for recurrent IHPS.

Main Methods:

  • A case study of an eight-week-old infant presenting with vomiting and failure to thrive.
  • Diagnostic imaging included pyloric ultrasound and an upper gastrointestinal series.
  • The infant underwent a second pyloromyotomy due to confirmed recurrent pyloric stenosis.

Main Results:

  • Ultrasound revealed a critically narrowed pylorus, suggestive of IHPS recurrence.
  • Upper gastrointestinal series confirmed recurrent pyloric stenosis.
  • The patient required a second surgical intervention.

Conclusions:

  • Prolonged vomiting post-pyloromyotomy warrants investigation for recurrent IHPS.
  • Upper gastrointestinal series is a valuable adjunct to ultrasound for diagnosing recurrent IHPS.
  • Accurate diagnosis is crucial for determining the need for a second pyloromyotomy.
Abstract

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