469 Over-reliance on ultrasonography in the diagnosis of HPS hypertrophic pyloric stenosis (HPS): a retrospective review at a specialist paediatric hospital

• Published in: Archives of disease in childhood Vol. 108; no. Suppl 2; pp. A232 - A233
• Main Authors: Omran, Kareem, Aftab, Muhammad, Yardley, Iain, Thakkar, Hemanshoo
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.07.2023
• Subjects: Dehydration; Diagnosis; Hospitals; Medical diagnosis; Patients; Pediatrics; Pyloric muscle; Scientific Concepts; Stenosis; Surgery; Ultrasonic imaging; Ultrasound; Vomiting
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.369

ObjectivesHypertrophic Pyloric Stenosis (HPS) is a rare condition affecting infants and is characterised by pyloric muscle thickening which leads to gastric outlet obstruction. This condition usually manifests in the first 3–6 weeks of life, with symptoms such as projectile vomiting, dehydration, and weight loss after consuming only small amounts of food. There is a predisposition towards males and a familial tendency. The hallmark of HPS diagnosis is the detection of a palpable ‘olive’ in the epigastric region through clinical examination, which becomes more pronounced following feeding. The diagnosis can also be confirmed via an ultrasound (US). Definitive management involves removal of the mass in surgery.1 This study aimed to evaluate the utilisation of ultrasonography in diagnosing HPS and the efficacy of clinical examination, at a tertiary paediatric specialist hospital.MethodsA retrospective hospital case note review was conducted from January 2018 to October 2022. All patients with HPS confirmed by surgery were included. Reviewed details included the availability of US scans at the referring hospital, clinical examinations performed at the institution, and imaging studies conducted prior to surgery. Clinical examination was considered positive in the presence of an olive on palpation of the epigastrium, either before or after a test feed.Results76 patients met the inclusion criteria (70 male, 6 female). A palpable olive was noted in 42/76 (55%) patients, rising up to 60/76 (79%) following a test feed. As shown in figure 1, 46/76 (61%) patients had an US performed at their local hospital, of which a further 12 (26%) went on to have a repeat US on admission, despite a positive clinical examination. of the 30/76 (39%) who did not receive a local US (shown in figure 2), 20 (67%) had an US at the tertiary hospital following a positive examination. In 16/34 (47%) patients who received a test feed, a palpable olive could not be felt, and in all cases an US was performed to confirm the diagnosis. No patient went to surgery without either a positive examination or ultrasound.ConclusionAt our institution, excessive reliance on ultrasonography in the diagnosis of HPS was noted, demonstrated by the high number of patients undergoing US scans despite positive clinical examination results. Although US is considered the preferred radiological imaging method, this study underscores the importance of elevating physicians’ trust in their diagnostic abilities, particularly in the context of a patient‘s history and positive examination findings.ReferenceGarfield K, Sergent SR. Pyloric Stenosis. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555931/?report=classicAbstract 469 Figure 1