A 3-year-old boy presented with postprandial vomiting and epigastric pain for 3 wk. Barium meal study suggested hypertrophic pyloric stenosis. Ultrasound of the stomach after water loading revealed an echogenic antral...A 3-year-old boy presented with postprandial vomiting and epigastric pain for 3 wk. Barium meal study suggested hypertrophic pyloric stenosis. Ultrasound of the stomach after water loading revealed an echogenic antral web with an eccentric aperture and distal antral hypertrophy.Subsequent endoscopy confirmed the ultrasound findings.Web resection and antropyloroplasty resulted in excellent recovery. To our knowledge, the barium meal and ultrasound findings of an antral web-associated distal antral hypertrophy and prepyloric stenosis has not previously been described.展开更多
Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of...Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of pCO<sub>2</sub> and BE in infants suspected to have IHPS. Methods: We collected data from 80 “surgical” infants younger than 100 days with prolonged nonbilious vomiting who were suspected to have IHPS. In 65 infants, pyloric stenosis was confirmed, and 15 infants had nonsurgical conditions. Capillary blood was tested for standard acid-base parameters and lactate. The two groups were compared. Results: Eighty-eight percent of the IHPS infants had elevated standard bicarbonate levels (st bicarb) > 25 mmol/l, and 60% had BE > 3.5 mmol/l;12% of the infants showed hypercapnia (pCO<sub>2</sub> ≥ 50 mmHg) associated with markedly increased standard bicarbonate and BE. Infants with nonsurgical vomiting were older at admission (p = 0.002), had a longer duration of vomiting (p < 0.001), were older (p = 0.002) and weighted more at admission (p = 0.004), had lower pCO<sub>2</sub> (p = 0.021), lower st bicarb (p < 0.001) and lower BE (p = 0.001). In addition, nonsurgical infants showed a trend to anemia (p = 0.002). Conclusions: In infants with IHPS/nonbilious vomiting, acid-base analysis (ABA) is equivocal or inconclusive. These findings may be misleading and could result in a false clinical decision. Nonsurgical vomiting is associated with a lower degree of alkalosis, normocapnia to slight hypercapnia and a base deficit. However, even infants with IHPS may present with a negative BE. In infants with IHPS and severe alkalosis, hypercapnia carries a risk for respiratory depression. Monitoring the infant’s respiration allows for the early detection of respiratory deterioration.展开更多
Osteopetrosis incidence is less than 1:200,000 births in most populations. It’s more common in consanguineous people as it’s unusual for two members of the same family. The incidence of Hypertrophic pyloric stenosis...Osteopetrosis incidence is less than 1:200,000 births in most populations. It’s more common in consanguineous people as it’s unusual for two members of the same family. The incidence of Hypertrophic pyloric stenosis is 1 in 300 - 900 newborns. Hypertrophic pyloric stenosis is due to hypertrophy of the smooth muscle of the pyloric sphincter. The classic age of occurrence is the first few months of life, and the classic presentation is non-bilious projectile vomiting after feeding. We report a rare association of osteopetrosis and pyloric stenosis in four siblings and osteopetrosis in three cousins. All four patients were operated on and followed by nephrology and metabolic departments for osteopetrosis and metabolic acidosis.展开更多
INTRODUCTIONAlthough laparoscopic herniorrhaphy is the most common procedure performed by pediatric surgeons at present, herniorrhaphy with an asymptomatic patent processus vaginalis (PPV) remains controversial. The...INTRODUCTIONAlthough laparoscopic herniorrhaphy is the most common procedure performed by pediatric surgeons at present, herniorrhaphy with an asymptomatic patent processus vaginalis (PPV) remains controversial. The incidence of contralateral PPV on laparoscopy in previous studies was reported as 20%-50%, but it is believed to approach 100% in premature infants. It has been reported that 4%-34% patients have the risk of developing subsequent metachronous contralateral hernia after a repair of an ipsilateral hernia.Iu If this is true, then the identification and closure of a PPV at the time of ipsilateral hernia repair will obviate the need for a second operation in thousands of children every year. With recent advances in minimally invasive surgery, transinguinal diagnostic laparoscopy has emerged as a safe and effective method for evaluating a pediatric patient with PPV. Meanwhile, the laparoscopy has been widely used to manage the infantile hypertrophic pyloric stenosis (IHPS), due to equally high success rate, minimal complications, and a shorter hospital stay.展开更多
Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for t...Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.展开更多
Achalasia is a type of esophageal motility disorder,consisting of relaxation dysfunction of the lower esophagus and disturbed esophageal peristalsis.Related clinical symptoms include dysphagia,regurgitation,chest pain...Achalasia is a type of esophageal motility disorder,consisting of relaxation dysfunction of the lower esophagus and disturbed esophageal peristalsis.Related clinical symptoms include dysphagia,regurgitation,chest pain,and weight loss.Traditional treatment options include endoscopic botulinum toxin injection,endoscopic pneumatic dilation,and laparoscopic Heller’s myotomy.These therapies mainly relieve symptoms by reducing the pressure on the lower esophageal sphincter and reducing blood flow resistance at the esophagogastric junction.Based on endoscopic submucosal dissection and natural orifice transluminal endoscopic surgery,peroral endoscopic myotomy(POEM)is a purely endoscopic method of myotomy with minimal invasiveness and a low rate of adverse events when performed by experienced operators.Since then,numerous studies have shown the significant clinical efficacy and safety of POEM.The purpose of this article is to introduce different modified POEMs,special indications for different POEMs,and their advantages as well as disadvantages.展开更多
Background: Hypertrophic pyloric stenosis is the most important cause for propulsive non-bilious vomiting in infants of the first trimester. Extramucous splitting of the hypertrophic pyloric muscle is the surgical gol...Background: Hypertrophic pyloric stenosis is the most important cause for propulsive non-bilious vomiting in infants of the first trimester. Extramucous splitting of the hypertrophic pyloric muscle is the surgical gold standard for treatment. Serious major complications of pyloromyotomy (PM) are mucosal perforation and incomplete muscle splitting. The aim of the presented study is to find out if intraoperative complications are predisposed by biometric or biochemical factors. Furthermore, we looked for the influence of the board certification of the primary surgeon. Patients and Methods: 162 infants with IHPS were operated during a six-year period (n = 150 laparoscopic operations). We had 8 major complications (4.9%): iatrogenic mucosal perforation occurred in 6 cases, and incomplete PM in 2 infants. Preoperative demographic data and data resulting from the blood acid-base- and ion-analysis were compared with data of a previously published reference group from our institution (Tr?bs RB. Open J Pediatr, 2014;4: 208-215). Results: The duration of vomiting, the grade of dehydration and the severity of blood alkalosis did not differ between both groups. Furthermore, we found no influence of the gestational age and birth weight on the occurrence of intraoperative complications. It seems that early postnatal age (p = 0.07) and low body weight at surgery (p = 0.055) may contribute to surgical problems. Board certification as a paediatric surgeon did not influence the rate of intraoperative complications. Conclusions: Laboratory data did not show any predisposition to intraoperative complications. It is assumed that small infants with early occurring symptoms carry an elevated risk for intraoperative events. Our data support the hypothesis that the rate of intraoperative complications at PM is mainly influenced by skills and experience of the surgeon.展开更多
Food allergy (FA) is a disease with increasing prevalence and a wide spectrum of clinical manifestations. These include the eosinophilic disorders, which can involve any segment of the gastrointestinal tract (GIT), in...Food allergy (FA) is a disease with increasing prevalence and a wide spectrum of clinical manifestations. These include the eosinophilic disorders, which can involve any segment of the gastrointestinal tract (GIT), including the stomach. In this context, three patients with a confirmed diagnosis of food allergy, who were initially diagnosed with pyloric hypertrophy, are presented. All cases showed an adequate response to nutritional management. It is essential to consider food allergy, such as eosinophilic gastroenteritis, as part of the differential diagnosis of gastric outlet obstruction in those patients who present vomiting secondary to pyloric hypertrophy.展开更多
文摘A 3-year-old boy presented with postprandial vomiting and epigastric pain for 3 wk. Barium meal study suggested hypertrophic pyloric stenosis. Ultrasound of the stomach after water loading revealed an echogenic antral web with an eccentric aperture and distal antral hypertrophy.Subsequent endoscopy confirmed the ultrasound findings.Web resection and antropyloroplasty resulted in excellent recovery. To our knowledge, the barium meal and ultrasound findings of an antral web-associated distal antral hypertrophy and prepyloric stenosis has not previously been described.
文摘Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of pCO<sub>2</sub> and BE in infants suspected to have IHPS. Methods: We collected data from 80 “surgical” infants younger than 100 days with prolonged nonbilious vomiting who were suspected to have IHPS. In 65 infants, pyloric stenosis was confirmed, and 15 infants had nonsurgical conditions. Capillary blood was tested for standard acid-base parameters and lactate. The two groups were compared. Results: Eighty-eight percent of the IHPS infants had elevated standard bicarbonate levels (st bicarb) > 25 mmol/l, and 60% had BE > 3.5 mmol/l;12% of the infants showed hypercapnia (pCO<sub>2</sub> ≥ 50 mmHg) associated with markedly increased standard bicarbonate and BE. Infants with nonsurgical vomiting were older at admission (p = 0.002), had a longer duration of vomiting (p < 0.001), were older (p = 0.002) and weighted more at admission (p = 0.004), had lower pCO<sub>2</sub> (p = 0.021), lower st bicarb (p < 0.001) and lower BE (p = 0.001). In addition, nonsurgical infants showed a trend to anemia (p = 0.002). Conclusions: In infants with IHPS/nonbilious vomiting, acid-base analysis (ABA) is equivocal or inconclusive. These findings may be misleading and could result in a false clinical decision. Nonsurgical vomiting is associated with a lower degree of alkalosis, normocapnia to slight hypercapnia and a base deficit. However, even infants with IHPS may present with a negative BE. In infants with IHPS and severe alkalosis, hypercapnia carries a risk for respiratory depression. Monitoring the infant’s respiration allows for the early detection of respiratory deterioration.
文摘Osteopetrosis incidence is less than 1:200,000 births in most populations. It’s more common in consanguineous people as it’s unusual for two members of the same family. The incidence of Hypertrophic pyloric stenosis is 1 in 300 - 900 newborns. Hypertrophic pyloric stenosis is due to hypertrophy of the smooth muscle of the pyloric sphincter. The classic age of occurrence is the first few months of life, and the classic presentation is non-bilious projectile vomiting after feeding. We report a rare association of osteopetrosis and pyloric stenosis in four siblings and osteopetrosis in three cousins. All four patients were operated on and followed by nephrology and metabolic departments for osteopetrosis and metabolic acidosis.
文摘INTRODUCTIONAlthough laparoscopic herniorrhaphy is the most common procedure performed by pediatric surgeons at present, herniorrhaphy with an asymptomatic patent processus vaginalis (PPV) remains controversial. The incidence of contralateral PPV on laparoscopy in previous studies was reported as 20%-50%, but it is believed to approach 100% in premature infants. It has been reported that 4%-34% patients have the risk of developing subsequent metachronous contralateral hernia after a repair of an ipsilateral hernia.Iu If this is true, then the identification and closure of a PPV at the time of ipsilateral hernia repair will obviate the need for a second operation in thousands of children every year. With recent advances in minimally invasive surgery, transinguinal diagnostic laparoscopy has emerged as a safe and effective method for evaluating a pediatric patient with PPV. Meanwhile, the laparoscopy has been widely used to manage the infantile hypertrophic pyloric stenosis (IHPS), due to equally high success rate, minimal complications, and a shorter hospital stay.
文摘Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.
文摘Achalasia is a type of esophageal motility disorder,consisting of relaxation dysfunction of the lower esophagus and disturbed esophageal peristalsis.Related clinical symptoms include dysphagia,regurgitation,chest pain,and weight loss.Traditional treatment options include endoscopic botulinum toxin injection,endoscopic pneumatic dilation,and laparoscopic Heller’s myotomy.These therapies mainly relieve symptoms by reducing the pressure on the lower esophageal sphincter and reducing blood flow resistance at the esophagogastric junction.Based on endoscopic submucosal dissection and natural orifice transluminal endoscopic surgery,peroral endoscopic myotomy(POEM)is a purely endoscopic method of myotomy with minimal invasiveness and a low rate of adverse events when performed by experienced operators.Since then,numerous studies have shown the significant clinical efficacy and safety of POEM.The purpose of this article is to introduce different modified POEMs,special indications for different POEMs,and their advantages as well as disadvantages.
文摘Background: Hypertrophic pyloric stenosis is the most important cause for propulsive non-bilious vomiting in infants of the first trimester. Extramucous splitting of the hypertrophic pyloric muscle is the surgical gold standard for treatment. Serious major complications of pyloromyotomy (PM) are mucosal perforation and incomplete muscle splitting. The aim of the presented study is to find out if intraoperative complications are predisposed by biometric or biochemical factors. Furthermore, we looked for the influence of the board certification of the primary surgeon. Patients and Methods: 162 infants with IHPS were operated during a six-year period (n = 150 laparoscopic operations). We had 8 major complications (4.9%): iatrogenic mucosal perforation occurred in 6 cases, and incomplete PM in 2 infants. Preoperative demographic data and data resulting from the blood acid-base- and ion-analysis were compared with data of a previously published reference group from our institution (Tr?bs RB. Open J Pediatr, 2014;4: 208-215). Results: The duration of vomiting, the grade of dehydration and the severity of blood alkalosis did not differ between both groups. Furthermore, we found no influence of the gestational age and birth weight on the occurrence of intraoperative complications. It seems that early postnatal age (p = 0.07) and low body weight at surgery (p = 0.055) may contribute to surgical problems. Board certification as a paediatric surgeon did not influence the rate of intraoperative complications. Conclusions: Laboratory data did not show any predisposition to intraoperative complications. It is assumed that small infants with early occurring symptoms carry an elevated risk for intraoperative events. Our data support the hypothesis that the rate of intraoperative complications at PM is mainly influenced by skills and experience of the surgeon.
文摘Food allergy (FA) is a disease with increasing prevalence and a wide spectrum of clinical manifestations. These include the eosinophilic disorders, which can involve any segment of the gastrointestinal tract (GIT), including the stomach. In this context, three patients with a confirmed diagnosis of food allergy, who were initially diagnosed with pyloric hypertrophy, are presented. All cases showed an adequate response to nutritional management. It is essential to consider food allergy, such as eosinophilic gastroenteritis, as part of the differential diagnosis of gastric outlet obstruction in those patients who present vomiting secondary to pyloric hypertrophy.