Ultrasound follow-up of infantile hypertrophic pyloric stenosis (IHPS) during conservative therapy: ultrasound findings as criteria for diagnosis and cure.
OBJECTIVE
During conservative therapy of infantile hypertrophic pyloric stenosis (IHPS) with atropine sulfate, there are many patients who do not achieve normal values of pyloric wall thickness and canal length even though they are clinically cured (vomiting has ceased); an objective criterion for cure has not yet been established. The aim of this study was to examine whether the appearance of pyloric wall stratification can be used as a criterion for cure.


METHODS
Twenty infants with IHPS who were treated conservatively were enrolled. Two of them ultimately required surgery. Ultrasound examinations were done serially and the pyloric wall thickness and canal length were measured. The echogenicity of the pyloric wall and the presence of wall stratification were noted.


RESULTS
On admission, all infants satisfied the ultrasound criteria for IHPS and had a heterogeneous pyloric wall without stratification. With conservative therapy, symptoms disappeared, the pyloric wall thickness and the canal length gradually decreased, the echogenicity gradually became homogeneous and hypoechoic, and wall stratification appeared (in most cases before the pyloric wall thickness and the canal length had normalized). The absence of wall stratification suggests that cellular interstitial changes, such as edema or inflammation, are present in the pyloric wall in the acute stage.


CONCLUSIONS
Pyloric wall stratification was absent during the acute stage, but it appeared after initiation of treatment but before the pyloric wall thickness and the canal length had normalized. The presence of pyloric wall stratification can be used as a criterion for cure; the absence of wall stratification can be added to ultrasound diagnostic criteria for IHPS.
Department of Radiology, Nara Medical University, 840 Shijo-Cho, Kashihara, 634-8522, Japan. sachimiu@naramed-u.ac.jp.
Sachiko
S
Miura
Department of Radiology, Nara Medical University, 840 Shijo-Cho, Kashihara, 634-8522, Japan.
Eijitsu
E
Haku
Department of Endoscopy and Ultrasound, Nara Medical University, Nara, Japan.
Toshiko
T
Hirai
Department of Endoscopy and Ultrasound, Nara Medical University, Nara, Japan.
Nagaaki
N
Marugami
Department of Radiology, Nara Medical University, 840 Shijo-Cho, Kashihara, 634-8522, Japan.
Takahiro
T
Itoh
Department of Radiology, Hoshigaoka Kouseinenkin Hospital, Osaka, Japan.
Takehiro
T
Tanaka
Department of Radiology, Nara Medical University, 840 Shijo-Cho, Kashihara, 634-8522, Japan.
Kimihiko
K
Kichikawa
Department of Endoscopy and Ultrasound, Nara Medical University, Nara, Japan.
Hajime
H
Ohishi
IHPS; atropine sulfate; conservative therapy; ultrasonography; wall stratification