Pediatric Gastroenterology, Hepatology & Nutrition

  • 제27권2호
  • /
  • Pages.88-94
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  • 2024
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  • 2234-8646(pISSN)
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  • 2234-8840(eISSN)
대한소아소화기영양학회 (The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition)
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Utility of Pyloric Length Measurement for Detecting Severe Metabolic Alkalosis in Infants with Hypertrophic Pyloric Stenosis

  • Hyun Jin Kim (Department of Pediatrics, Chungnam National University College of Medicine, Chungnam National University Hospital)
  • 투고 : 2023.06.02
  • 심사 : 2023.09.27
  • 발행 : 2024.03.15
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초록

Purpose: Infantile hypertrophic pyloric stenosis (IHPS) is a common gastrointestinal disease in neonates and hypochloremia metabolic alkalosis is a typical laboratory finding in affected patients. This study aimed to analyze the clinical characteristics of infants with IHPS and evaluate the association of clinical and laboratory parameters with ultrasonographic findings. Methods: Infants diagnosed with IHPS between January 2017 and July 2022 were retrospectively evaluated. Results: A total of 67 patients were included in the study. The mean age at diagnosis was 40.5±19.59 days, and the mean symptom duration was 11.97±9.91 days. The mean pyloric muscle thickness and pyloric canal length were 4.87±1.05 mm and 19.6±3.46 mm, respectively. Hyponatremia and metabolic alkalosis were observed in five (7.5%) and 36 (53.7%) patients, respectively. Serum sodium (p=0.011), potassium (p=0.023), and chloride levels (p=0.015) were significantly lower in patients with high bicarbonate levels (≥30 mmol/L). Furthermore, pyloric canal length was significantly higher in patients with high bicarbonate levels (p=0.015). To assess metabolic alkalosis in IHPS patients, the area under the receiver operating characteristic curve of pyloric canal length was 0.910 and the optimal cutoff value of the pyloric canal length was 23.5 mm. Conclusion: We found a close association between laboratory and ultrasonographic findings of IHPS. Clinicians should give special consideration to patients with pyloric lengths exceeding 23.5 mm and appropriate fluid rehydration should be given to these patients.

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참고문헌

  1. Peeters B, Benninga MA, Hennekam RCM. Infantile hypertrophic pyloric stenosis-genetics and syndromes. Nat Rev Gastroenterol Hepatol 2012;9:646-60. https://doi.org/10.1038/nrgastro.2012.133
  2. Taylor ND, Cass DT, Holland AJA. Infantile hypertrophic pyloric stenosis: has anything changed? J Paediatr Child Health 2013;49:33-7. https://doi.org/10.1111/jpc.12027
  3. Peters B, Oomen MW, Bakx R, Benninga MA. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol 2014;8:533-41. https://doi.org/10.1586/17474124.2014.903799
  4. Gezer H, Oguzkurt P, Temiz A, Hicsonmez A. Hypertrophic pyloric stenosis in twins; genetic or environmental factors. Clin Genet 2015;87:388-91. https://doi.org/10.1111/cge.12399
  5. Chuang YH, Chao HC, Yeh HY, Lai MW, Chen CC. Factors associated with pyloric hypertrophy severity and post-operative feeding and nutritional recovery in infantile hypertrophic pyloric stenosis. Biomed J 2022;45:948-56. https://doi.org/10.1016/j.bj.2021.12.011
  6. AlMaramhy HH. Is there a relation between pyloric muscle thickness and clinical and laboratory data in infants with hypertrophic pyloric stenosis? Indian J Surg 2015;77:827-30. https://doi.org/10.1007/s12262-013-1021-2
  7. van den Bunder FAIM, van Wijk L, van Woensel JBM, Stevens MF, van Heurn LWE, Derikx JPM. Perioperative apnea in infants with hypertrophic pyloric stenosis: a systematic review. Paediatr Anaesth 2020;30:749-58. https://doi.org/10.1111/pan.13879
  8. van den Bunder FAIM, van Woensel JBM, Stevens MF, van de Brug T, van Heurn LWE, Derikx JPM. Respiratory problems owing to severe metabolic alkalosis in infants presenting with hypertrophic pyloric stenosis. J Pediatr Surg 2020;55:2772-6. https://doi.org/10.1016/j.jpedsurg.2020.05.041
  9. Hussain M. Sonographic diagnosis of infantile hypertrophic pyloric stenosis-use of simultaneous greyscale & colour doppler examination. Int J Health Sci (Qassim) 2008;2:134-40.
  10. Zaghal A, El-Majzoub N, Jaafar R, Aoun B, Jradi N. Brief overview and updates on infantile hypertrophic pyloric stenosis: focus on perioperative management. Pediatr Ann 2021;50:e136-41. https://doi.org/10.3928/19382359-20210215-01
  11. Rich BS, Dolgin SE. Hypertrophic pyloric stenosis. Pediatr Rev 2021;42:539-45. https://doi.org/10.1542/pir.2020-003277
  12. Vermes G, Matrai A, Czeizel AE, Acs N. Birth outcomes of male and female patients with infantile hypertrophic pyloric stenosis--a population-based case-control study. J Matern Fetal Neonatal Med 2016;29:1777-82.
  13. Huang IF, Tiao MM, Chiou CC, Shih HH, Hu HH, Ruiz JP. Infantile hypertrophic pyloric stenosis before 3 weeks of age in infants and preterm babies. Pediatr Int 2011;53:18-23. https://doi.org/10.1111/j.1442-200X.2010.03185.x
  14. Mcheik JN, Dichamp I, Levard G, Ragot S, Beby-Defaux A, Grosos C, et al. Infantile hypertrophic pyloric stenosis: are viruses involved? J Med Virol 2010;82:2087-91. https://doi.org/10.1002/jmv.21913
  15. Touloukian RJ, Higgins E. The spectrum of serum electrolytes in hypertrophic pyloric stenosis. J Pediatr Surg 1983;18:394-7.
  16. Chalya PL, Manyama M, Kayange NM, Mabula JB, Massenga A. Infantile hypertrophic pyloric stenosis at a tertiary care hospital in Tanzania: a surgical experience with 102 patients over a 5-year period. BMC Res Notes 2015;18:690.
  17. Vinycomb TI, Laslett K, Gwini SM, Teague W, Nataraja RM. Presentation and outcomes in hypertrophic pyloric stenosis: an 11-year review. J Paediatr Child Health 2019;55:1183-7. https://doi.org/10.1111/jpc.14372
  18. Williams T, Cosgrove M. Evaluation of vomiting in children. Paediatr Child Health 2012;22:419-25. https://doi.org/10.1016/j.paed.2012.04.003
  19. Ulusoy O, Aydin E, Karakurt AG. Evaluation of risk factors affecting metabolic alkalosis in infantile hypertrophic pyloric stenosis. J Tepecik Educ Res Hosp 2022;32:273-8. https://doi.org/10.4274/terh.galenos.2022.68335
  20. Graham KA, Laituri CA, Markel TA, Ladd AP. A review of postoperative feeding regimens in infantile hypertrophic pyloric stenosis. J Pediatr Surg 2013;48:2175-9. https://doi.org/10.1016/j.jpedsurg.2013.04.023