Diagnosis and treatment of primary hypertrophic pyloric stenosis (HPS) in older children

• DOI: 10.1016/j.epsc.2021.101860
• Publication Date: 2021-04-16T13:17:09Z
• Authors: C. Plessi; M. Sica; F. Molinaro; G. Fusi; F. Rossi; M. Costantini; F. Roviello; L. Marano; A. D'ignazio; C. Spinelli; R. Angotti
• Keywords: Esophagogastroduodenoscopy; Pyloric Stenosis; Hypertrophic Pyloric Stenosis; Upper gastrointestinal series; Pyloromyotomy

Hypertrophic pyloric stenosis (HPS) is the most important cause of non-bilious vomiting during infancy and it usually idiopathic. It very rare in older children adolescents, which gastric outlet obstruction (GOO) more typically secondary to other conditions. Gastrointestinal malformation are frequently associated with Down syndrome some them (especially duodenal abnormalities) can be detected quite late. In infants standard treatment HPS represented by a Ramstedt pyloromyotomy, while adults distal resection indicated Billroth I or II reconstruction. We present an unusual case 12-year-old girl syndrome, diagnosed late-onset HPS. She came our attention periodic growth delay. underwent multiple imaging examinations, highlighted presence Based on patient's age thickness muscle, we decided perform partial gastrectomy Roux-en-y Patient was discharged X day. now follow up, gains weight presents good but possible childhood adolescence. Diagnosis performed through ultrasounds (US) upper gastrointestinal radiological series (UGI), sometimes further examinations required (abdominal MRI, esophagogastroduodenoscopy). since less invasive techniques not effective, have consider gastrectomy. experience, reconstruction valid option, poor complication quality life.