CONGENITAL HYPERTROPHIC PYLORIC STENOSIS

A 22 day old male presented with c/o vomiting after meals since birth (CLICK ON THE IMAGES TO ZOOM)

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It refers to the idiopathic thickening of gastric py­loric musculature which then results in progressive gastric outlet obstruction.
2-5 cases per 1000 births.
Clinical presentation:
It typically clinically manifests between 6 to 12 weeks of age.
Clinical presentation is typical with non-bilious projectile vomiting.
Symptoms may start as early as 3 weeks of age.

Associations: 

• Turner syndrome.
• Oesophageal atresia.
• Tracheo-esophageal fistula
• Trisomy 18

ON plain abdominal radiograph:

Abdominal x-ray findings are non-specific but may show a distended stomach with minimal distal intestinal bowel gas


Ultrasound is the modality of choice
The hypertrophied muscle is hypoechoic, and the central mucosa is hyperechoic. ( Target sign of pyloric stenosis)
pyloric muscle thickness, i.e. diame­ter of a single muscular wall on a transverse image: >3 mm (most accurate)
Length, i.e. longitudinal measurement: >15-17 mm
pyloric transverse diameter: >13 mm