title: Infantile hypertrophic pyloric stenosis at a tertiary care hospital in Tanzania: a surgical experience with 102 patients over a 5-year period.
abstract: BACKGROUND
  Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. There is paucity of published data regarding this condition in our setting. This study describes the clinical presentation, mode of treatment and outcome of treatment of this disease and identifies factors responsible for poor outcome of these patients.
  
  
  METHODS
  This was a descriptive retrospective study of infants with HPS admitted to Bugando Medical Centre and subsequently underwent surgery between February 2009 and January 2014.
  
  
  RESULTS
  A total of 102 patients (M:F = 4.7:1) were studied. The median age at presentation was 5 weeks. The median duration of illness was 4 weeks. Fifty-four (52.9 %) patients occur in first-born children. Associated anomalies were reported in 7 (6.9 %) patients. Non-bilious vomiting was the most frequent symptom and it was described in all (100 %) patients. A palpable mass was found in 23.5 % of infants. The diagnosis of IHPS was made clinically in 86 (84.3 %) and by ultrasound in 16 (15.7 %) patients. The treatment was Ramstedt's pyloromyotomy in all cases. There were 6 (5.9 %) intra-operative mucosal perforations which were repaired successively. Postoperative complication was 11.8 %. The median length of hospital stay was 12 days and it was significantly associated with prolonged pre-operative hospitalization (p = 0.001). The mortality rate was 4.9 %. Age below 2 weeks, late presentation (≥14 days), severe dehydration on admission, hypokalaemia on admission and surgical site infection were the main predictors of mortality (p < 0.001).
  
  
  CONCLUSIONS
  This study has shown that IHPS is a common condition in our setting. Age <2 weeks, delayed presentation, prolonged preoperative hospital stay, surgical site infection and high proportion of dehydration and electrolyte disturbance were the main predictors of poor outcome. A high index of suspicion is needed in infants with non-bilious vomiting to avoid delay in diagnosis.
authors.affiliation: Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania. drphillipoleo@yahoo.com.
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
authors.affiliation: Department of Anatomy, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. mmajfe@hotmail.com.
authors.forename: Mange
authors.initials: M
authors.lastname: Manyama
authors.affiliation: Department of Pediatrics, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. n_eema@yahoo.com.
authors.forename: Neema M
authors.initials: NM
authors.lastname: Kayange
authors.affiliation: Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania. drjbmabula@yahoo.com.|Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. drjbmabula@yahoo.com.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Mabula
authors.affiliation: Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania. massenga1@yahoo.com.|Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. massenga1@yahoo.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Massenga
mesh_terms: D005260:Female; D017219:Gastric Outlet Obstruction / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications; D046248:Pyloric Stenosis, Hypertrophic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D013636:Tanzania; D063128:Tertiary Health Care; D016896:Treatment Outcome; D014839:Vomiting / Q000175:diagnosis / Q000209:etiology