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Pyloric Stenosis: Diagnosis and Management

There are few pediatric illnesses as gratifying to diagnose and as immediately responsive to treatment as infantile hypertrophic pyloric stenosis (IHPS).

Anxious parents can be reassured convincingly by the knowledgeable clinician who, upon hearing a suggestive history and with palpation alone, conclusively establishes a diagnosis and confidently recommends an invariably effective mechanical solution. An updated awareness of current evaluation and management of IHPS should be part of every pediatrician's armamentarium. Real-time ultrasonography has moved into a dominant role in the evaluation of any infant suspected of having IHPS whose diagnosis cannot be confirmed by the characteristic history coupled with the classic feel of an olive-shaped mass in the right upper quadrant. X-ray study of the stomach with barium should be reserved for those select patients who present confusing or indistinct diagnostic features; it should not be ordered indiscriminately by the pediatrician who suspects IHPS.

HISTORIC PERSPECTIVE

Although the physical signs and symptoms of pyloric stenosis were described as early as 1717 in Europe and 1788 in America, it was not until 1887 that the pathology and clinical features of pyloric stenosis were described accurately by the Danish pediatrician Hirschsprung.¹

Conservative treatment was attempted during the end of the 19th century but was rarely successful.

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