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Infantile hypertrophic pyloric stenosis in an extremely preterm male twin; a case report and review.

Kumar TR, Srikanth C - J Indian Assoc Pediatr Surg (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Vaatsalya Hospital, Venkata Padma Health Care Complex, Vizianagram, Andhra Pradesh, India.

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Sir, Infantile hypertrophic pyloric stenosis (IHPS) is quite rare in extremely preterm babies [born at or before 28 weeks of gestation (GW)]... A 42-day-old preterm, male baby [twin B] born at 28 GW with low birth weight (LBW) of 900 g, along with his sister (twin A weighing 1000 g) was refereed to us with a diagnosis of severe gastroesophageal reflux (GER)... Ultrasound abdomen demonstrated hypertrophied pyloric wall, measuring 16 × 14 × 6 mm in length, external diameter wall and thickness, respectively [Figure 1]... After resuscitation at surgery, a 2 × 1.5-cm white glistening, pliable, elongated, and thickened pylorus was found hence pyloromyotomy was performed... Postoperatively, baby required 6 h of mechanical ventilation, accepted oral feeds on day 2 and was discharged home on day 4... Baby is thriving well... Even in twins, males have a higher risk of developing IHPS than females, Preterm babies with IHPS present later during the 5 week of life; when compared to 3 week in term infants... However, when gestational age is considered, IHPS, in fact presents earlier in preterm babies (between 32 and 42 GW) than in term ones (45-52 weeks) because both require certain degree of extra-uterine maturation of the gut... This gastrointestinal (GI) maturation leading to hypertrophic pylorus occurs quite early and rapidly in preterm babies... Mild or even absence of classical electrolyte and acid base disturbances of IHPS, are attributed to the proportionate loss of water and sodium from a relatively large extracellular fluid volume and relatively less secretion of gastric acid in the preterm... The pyloric mass is softer, more pliable, less gritty, and thinner in preterms than in term infants... Prolonged medical treatment associated with delayed diagnosis and malnutrition increase the postoperative complications and recovery time which is due to physiological immaturity of the organs and LBW of a preterm rather than IHPS per se... Early surgical intervention can decrease the morbidity and mortality.

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(a) Showing dizygotic opposite sex twins with low-birth weight male twin having a surgical scar of pyloromyotomy. (b) Ultrasonography image showing classical target sign [Left] and longitudinal section image [Right] showing pyloric dimensions suggestive of IHPS
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Figure 1: (a) Showing dizygotic opposite sex twins with low-birth weight male twin having a surgical scar of pyloromyotomy. (b) Ultrasonography image showing classical target sign [Left] and longitudinal section image [Right] showing pyloric dimensions suggestive of IHPS

Mentions: A 42-day-old preterm, male baby [twin B] born at 28 GW with low birth weight (LBW) of 900 g, along with his sister (twin A weighing 1000 g) was refereed to us with a diagnosis of severe gastroesophageal reflux (GER). Twin B had repeated copious, nonbilious, nonprojectile vomiting after every feed; followed by voracious appetite since 4th week of life. Examination revealed a very small dehydrated infant weighing 1,300 g, with epigastric fullness and weak visible gastric peristalsis (VGP). The pyloric “olive” was not palpable. Arterial blood gases revealed mild metabolic alkalosis. There was hyponatremia, hypokalemia, and hypochloremia. X-ray abdomen showed air distended stomach with a paucity of intestinal gas. Ultrasound abdomen demonstrated hypertrophied pyloric wall, measuring 16 × 14 × 6 mm in length, external diameter wall and thickness, respectively [Figure 1]. After resuscitation at surgery, a 2 × 1.5-cm white glistening, pliable, elongated, and thickened pylorus was found hence pyloromyotomy was performed. Postoperatively, baby required 6 h of mechanical ventilation, accepted oral feeds on day 2 and was discharged home on day 4. Baby is thriving well. His sister, twin A is under observation.


Infantile hypertrophic pyloric stenosis in an extremely preterm male twin; a case report and review.

Kumar TR, Srikanth C - J Indian Assoc Pediatr Surg (2014)

(a) Showing dizygotic opposite sex twins with low-birth weight male twin having a surgical scar of pyloromyotomy. (b) Ultrasonography image showing classical target sign [Left] and longitudinal section image [Right] showing pyloric dimensions suggestive of IHPS
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4155641&req=5

Figure 1: (a) Showing dizygotic opposite sex twins with low-birth weight male twin having a surgical scar of pyloromyotomy. (b) Ultrasonography image showing classical target sign [Left] and longitudinal section image [Right] showing pyloric dimensions suggestive of IHPS
Mentions: A 42-day-old preterm, male baby [twin B] born at 28 GW with low birth weight (LBW) of 900 g, along with his sister (twin A weighing 1000 g) was refereed to us with a diagnosis of severe gastroesophageal reflux (GER). Twin B had repeated copious, nonbilious, nonprojectile vomiting after every feed; followed by voracious appetite since 4th week of life. Examination revealed a very small dehydrated infant weighing 1,300 g, with epigastric fullness and weak visible gastric peristalsis (VGP). The pyloric “olive” was not palpable. Arterial blood gases revealed mild metabolic alkalosis. There was hyponatremia, hypokalemia, and hypochloremia. X-ray abdomen showed air distended stomach with a paucity of intestinal gas. Ultrasound abdomen demonstrated hypertrophied pyloric wall, measuring 16 × 14 × 6 mm in length, external diameter wall and thickness, respectively [Figure 1]. After resuscitation at surgery, a 2 × 1.5-cm white glistening, pliable, elongated, and thickened pylorus was found hence pyloromyotomy was performed. Postoperatively, baby required 6 h of mechanical ventilation, accepted oral feeds on day 2 and was discharged home on day 4. Baby is thriving well. His sister, twin A is under observation.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery, Vaatsalya Hospital, Venkata Padma Health Care Complex, Vizianagram, Andhra Pradesh, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, Infantile hypertrophic pyloric stenosis (IHPS) is quite rare in extremely preterm babies [born at or before 28 weeks of gestation (GW)]... A 42-day-old preterm, male baby [twin B] born at 28 GW with low birth weight (LBW) of 900 g, along with his sister (twin A weighing 1000 g) was refereed to us with a diagnosis of severe gastroesophageal reflux (GER)... Ultrasound abdomen demonstrated hypertrophied pyloric wall, measuring 16 × 14 × 6 mm in length, external diameter wall and thickness, respectively [Figure 1]... After resuscitation at surgery, a 2 × 1.5-cm white glistening, pliable, elongated, and thickened pylorus was found hence pyloromyotomy was performed... Postoperatively, baby required 6 h of mechanical ventilation, accepted oral feeds on day 2 and was discharged home on day 4... Baby is thriving well... Even in twins, males have a higher risk of developing IHPS than females, Preterm babies with IHPS present later during the 5 week of life; when compared to 3 week in term infants... However, when gestational age is considered, IHPS, in fact presents earlier in preterm babies (between 32 and 42 GW) than in term ones (45-52 weeks) because both require certain degree of extra-uterine maturation of the gut... This gastrointestinal (GI) maturation leading to hypertrophic pylorus occurs quite early and rapidly in preterm babies... Mild or even absence of classical electrolyte and acid base disturbances of IHPS, are attributed to the proportionate loss of water and sodium from a relatively large extracellular fluid volume and relatively less secretion of gastric acid in the preterm... The pyloric mass is softer, more pliable, less gritty, and thinner in preterms than in term infants... Prolonged medical treatment associated with delayed diagnosis and malnutrition increase the postoperative complications and recovery time which is due to physiological immaturity of the organs and LBW of a preterm rather than IHPS per se... Early surgical intervention can decrease the morbidity and mortality.

No MeSH data available.


Related in: MedlinePlus