Gastric outlet obstruction after long-term prostaglandin administration mimicking hypertrophic pyloric stenosis.
Prostaglandin E1 (PGE1) is widely used in neonates with cyanotic congenital heart disease who depend on the patency of the ductus arteriosus for oxygenation. Side effects of prostaglandin therapy are common and include respiratory depression, generalized flushing, and cardiovascular and neurological effects. Little is known about the complex effects on the gastrointestinal tract. We report on an infant with gastric outlet obstruction after long-term prostaglandin administration. At the age of 1 month, feeding problems developed with projectile vomiting. Ultrasonography showed progressive elongation of the antropyloric channel without wall thickening, which was causing gastric outlet obstruction. Three days after cardiac surgery and cessation of prostaglandin therapy, the infant fed normally and rapidly gained weight. The clinical signs in such patients can mimic hypertrophic pyloric stenosis. Therefore, the sonographic findings should not be confused with pyloric wall thickening to avoid a false diagnosis and unnecessary surgery. The symptoms diminish with cessation of the prostaglandin therapy after a corrective cardiac operation.
Lacher
M
M
Kinderchirurgische Klinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Munich, Germany. Martin.Lacher@med.uni-muenchen.de
Schneider
K
K
Dalla Pozza
R
R
Schweinitz
D V
DV
D000527:Alprostadil / Q000008:administration & dosage / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004374:Ductus Arteriosus, Patent / Q000188:drug therapy* / Q000601:surgery; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D046248:Pyloric Stenosis, Hypertrophic / Q000175:diagnosis*; D014463:Ultrasonography; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects*
D014665:Vasodilator Agents; D000527:Alprostadil