Recurrent hypertrophic pyloric stenosis, diagnosis and early surgery: a comprehensive review

Recurrent pyloric stenosis (RPS) is a very rare condition that occurs after an initially successful pyloromyotomy for hypertrophic pyloric stenosis. Over the last decade, the number of reported cases of recurrent pyloric stenosis has increased considerably. Given the rarity of this condition and the paucity of literature on the subject, there is a certain diagnostic difficulty, particularly at ultrasound level, where it is difficult to differentiate a true recurrence of pyloric stenosis from an initial incomplete pyloromyotomy.

A systematic literature review was performed to characterize the diagnosis of RPS and to report on all cases previously described in literature.

We identified a total of 15 patients (median age of 19 days at first pyloromyotomy; average of 31 days of symptom-free interval before RPS; 66.7% male). Eleven cases fulfilled the 3 Kuckelman criteria for RPS (weight gain, 3 weeks resolution of symptoms, restenosis on imaging). The length of the pylorus on ultrasound appears to increase or remain above 18 mm for RPS, where normally it should decrease immediately after pyloromyotomy. RPS seems to occur more frequently when the first pyloromyotomy is performed at an early age.

Hypertrophy of the pyloric muscle is a progressive entity, and if operated upon too early can favor recurrence. The diagnosis of a RPS can be made through the combination of clinical criteria and ultrasound, specifically length measurements of the pylorus. Additional studies need to be performed to confirm our findings and to define strategies to reduce risks for RPS.