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Pediatrics
Diagnosis
Gastrointestinal
Upper Gastrointestinal Abnormalities Typically Seen in Infants and Young Children
Hypertrophic Pyloric Stenosis
Hypertrophic Pyloric Stenosis
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Pyloric stenosis, hypertrophic pyloric stenosis (HPS)

            • Definitions

              • Idiopathic pyloric muscle thickening → progressive gastric outlet obstruction
              • Typically seen in infants 2-12 weeks old with progressive nonbilious projectile vomiting

            IMAGING

            • General Features

              • Radiographic Findings

                • Fluoroscopic Findings

                  • CT Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Bakal U et al: Recent changes in the features of hypertrophic pyloric stenosis. Pediatr Int. 58(5): 369-71, 2016
                                        2. Eberly MD et al: Azithromycin in early infancy and pyloric stenosis. Pediatrics. 135(3):483-8, 2015
                                        3. Raske ME et al: ACR appropriateness criteria vomiting in infants up to 3 months of age. J Am Coll Radiol. 12(9):915-22, 2015
                                        4. Stark CM et al: Association of prematurity with the development of infantile hypertrophic pyloric stenosis. Pediatr Res. 78(2):218-22, 2015
                                        5. Aboagye J et al: Age at presentation of common pediatric surgical conditions: Reexamining dogma. J Pediatr Surg. 49(6):995-9, 2014
                                        6. Lund M et al: Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ. 348:g1908, 2014
                                        7. Soyer T et al: Transient hypertrophic pyloric stenosis due to prostoglandin infusion. J Perinatol. 34(10):800-1, 2014
                                        8. Svenningsson A et al: Maternal and pregnancy characteristics and risk of infantile hypertrophic pyloric stenosis. J Pediatr Surg. 49(8):1226-31, 2014
                                        9. McAteer JP et al: Role of bottle feeding in the etiology of hypertrophic pyloric stenosis. JAMA Pediatr. 167(12):1143-9, 2013
                                        10. Bensard DD et al: Use of ultrasound measurements to direct laparoscopic pyloromyotomy in infants. JSLS. 14(4):553-7, 2010
                                        11. Bhargava P et al: Gastric pneumatosis and portal venous gas: benign findings in hypertrophic pyloric stenosis. Pediatr Radiol. 39(4):413, 2009
                                        12. Sola JE et al: Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis. J Pediatr Surg. 44(8):1631-7, 2009
                                        13. Cohen HL et al: The sonographic double-track sign: not pathognomonic for hypertrophic pyloric stenosis; can be seen in pylorospasm. J Ultrasound Med. 23(5):641-6, 2004
                                        14. Hall NJ et al: Meta-analysis of laparoscopic versus open pyloromyotomy. Ann Surg. 240(5):774-8, 2004
                                        15. Helton KJ et al: The impact of a clinical guideline on imaging children with hypertrophic pyloric stenosis. Pediatr Radiol. 34(9):733-6, 2004
                                        16. Huang YC et al: Medical treatment with atropine sulfate for hypertrophic pyloric stenosis. Acta Paediatr Taiwan. 45(3):136-40, 2004
                                        17. Yagmurlu A et al: Comparison of the incidence of complications in open and laparoscopic pyloromyotomy: a concurrent single institution series. J Pediatr Surg. 39(3):292-6; discussion 292-6, 2004
                                        18. Hernanz-Schulman M et al: Hypertrophic pyloric stenosis in infants: US evaluation of vascularity of the pyloric canal. Radiology. 229(2):389-93, 2003
                                        19. Hernanz-Schulman M: Infantile hypertrophic pyloric stenosis. Radiology. 227(2):319-31, 2003
                                        20. Sorensen HT et al: Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 35(2):104-6, 2003
                                        21. Kakish KS: Cystic fibrosis and infantile hypertrophic pyloric stenosis: is there an association? Pediatr Pulmonol. 33(5):404-5, 2002
                                        22. Hernanz-Schulman M et al: In vivo visualization of pyloric mucosal hypertrophy in infants with hypertrophic pyloric stenosis: is there an etiologic role? AJR Am J Roentgenol. 177(4):843-8, 2001
                                        23. Kawahara H et al: Motor abnormality in the gastroduodenal junction in patients with infantile hypertrophic pyloric stenosis. J Pediatr Surg. 36(11):1641-5, 2001
                                        24. Kobayashi H et al: Pyloric stenosis: new histopathologic perspective using confocal laser scanning. J Pediatr Surg. 36(8):1277-9, 2001
                                        25. Aktug T et al: Analyzing the diagnostic efficiency of olive palpation for hypertrophic pyloric stenosis. J Pediatr Surg. 34(10):1585-6, 1999
                                        26. Callahan MJ et al: The development of hypertrophic pyloric stenosis in a patient with prostaglandin-induced foveolar hyperplasia. Pediatr Radiol. 29(10):748-51, 1999
                                        27. Bisset GS 3rd et al: Pediatric imaging perspective: the vomiting infant. J Pediatr. 133(2):306-7, 1998
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Pyloric stenosis, hypertrophic pyloric stenosis (HPS)

                                                  • Definitions

                                                    • Idiopathic pyloric muscle thickening → progressive gastric outlet obstruction
                                                    • Typically seen in infants 2-12 weeks old with progressive nonbilious projectile vomiting

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • Fluoroscopic Findings

                                                        • CT Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Bakal U et al: Recent changes in the features of hypertrophic pyloric stenosis. Pediatr Int. 58(5): 369-71, 2016
                                                                              2. Eberly MD et al: Azithromycin in early infancy and pyloric stenosis. Pediatrics. 135(3):483-8, 2015
                                                                              3. Raske ME et al: ACR appropriateness criteria vomiting in infants up to 3 months of age. J Am Coll Radiol. 12(9):915-22, 2015
                                                                              4. Stark CM et al: Association of prematurity with the development of infantile hypertrophic pyloric stenosis. Pediatr Res. 78(2):218-22, 2015
                                                                              5. Aboagye J et al: Age at presentation of common pediatric surgical conditions: Reexamining dogma. J Pediatr Surg. 49(6):995-9, 2014
                                                                              6. Lund M et al: Use of macrolides in mother and child and risk of infantile hypertrophic pyloric stenosis: nationwide cohort study. BMJ. 348:g1908, 2014
                                                                              7. Soyer T et al: Transient hypertrophic pyloric stenosis due to prostoglandin infusion. J Perinatol. 34(10):800-1, 2014
                                                                              8. Svenningsson A et al: Maternal and pregnancy characteristics and risk of infantile hypertrophic pyloric stenosis. J Pediatr Surg. 49(8):1226-31, 2014
                                                                              9. McAteer JP et al: Role of bottle feeding in the etiology of hypertrophic pyloric stenosis. JAMA Pediatr. 167(12):1143-9, 2013
                                                                              10. Bensard DD et al: Use of ultrasound measurements to direct laparoscopic pyloromyotomy in infants. JSLS. 14(4):553-7, 2010
                                                                              11. Bhargava P et al: Gastric pneumatosis and portal venous gas: benign findings in hypertrophic pyloric stenosis. Pediatr Radiol. 39(4):413, 2009
                                                                              12. Sola JE et al: Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis. J Pediatr Surg. 44(8):1631-7, 2009
                                                                              13. Cohen HL et al: The sonographic double-track sign: not pathognomonic for hypertrophic pyloric stenosis; can be seen in pylorospasm. J Ultrasound Med. 23(5):641-6, 2004
                                                                              14. Hall NJ et al: Meta-analysis of laparoscopic versus open pyloromyotomy. Ann Surg. 240(5):774-8, 2004
                                                                              15. Helton KJ et al: The impact of a clinical guideline on imaging children with hypertrophic pyloric stenosis. Pediatr Radiol. 34(9):733-6, 2004
                                                                              16. Huang YC et al: Medical treatment with atropine sulfate for hypertrophic pyloric stenosis. Acta Paediatr Taiwan. 45(3):136-40, 2004
                                                                              17. Yagmurlu A et al: Comparison of the incidence of complications in open and laparoscopic pyloromyotomy: a concurrent single institution series. J Pediatr Surg. 39(3):292-6; discussion 292-6, 2004
                                                                              18. Hernanz-Schulman M et al: Hypertrophic pyloric stenosis in infants: US evaluation of vascularity of the pyloric canal. Radiology. 229(2):389-93, 2003
                                                                              19. Hernanz-Schulman M: Infantile hypertrophic pyloric stenosis. Radiology. 227(2):319-31, 2003
                                                                              20. Sorensen HT et al: Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 35(2):104-6, 2003
                                                                              21. Kakish KS: Cystic fibrosis and infantile hypertrophic pyloric stenosis: is there an association? Pediatr Pulmonol. 33(5):404-5, 2002
                                                                              22. Hernanz-Schulman M et al: In vivo visualization of pyloric mucosal hypertrophy in infants with hypertrophic pyloric stenosis: is there an etiologic role? AJR Am J Roentgenol. 177(4):843-8, 2001
                                                                              23. Kawahara H et al: Motor abnormality in the gastroduodenal junction in patients with infantile hypertrophic pyloric stenosis. J Pediatr Surg. 36(11):1641-5, 2001
                                                                              24. Kobayashi H et al: Pyloric stenosis: new histopathologic perspective using confocal laser scanning. J Pediatr Surg. 36(8):1277-9, 2001
                                                                              25. Aktug T et al: Analyzing the diagnostic efficiency of olive palpation for hypertrophic pyloric stenosis. J Pediatr Surg. 34(10):1585-6, 1999
                                                                              26. Callahan MJ et al: The development of hypertrophic pyloric stenosis in a patient with prostaglandin-induced foveolar hyperplasia. Pediatr Radiol. 29(10):748-51, 1999
                                                                              27. Bisset GS 3rd et al: Pediatric imaging perspective: the vomiting infant. J Pediatr. 133(2):306-7, 1998