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CASE VIDEO
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 206

Peristaltic waves: A clinical clue of infantile hypertrophic pyloric stenosis


Department of Pediatrics and Neonatology, Ankura Hospital for Women and Children, Hyderabad, Telangana, India

Date of Submission08-Jul-2021
Date of Decision09-Aug-2021
Date of Acceptance22-Aug-2021
Date of Web Publication31-Aug-2021

Correspondence Address:
Dr/ Chanchal Kumar
Department of Pediatrics and Neonatology, Ankura Hospital for Women and Children, Banjara Hills, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipcares.ipcares_215_21

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How to cite this article:
Pothala R, Narahari KK, Kumar C. Peristaltic waves: A clinical clue of infantile hypertrophic pyloric stenosis. Indian Pediatr Case Rep 2021;1:206

How to cite this URL:
Pothala R, Narahari KK, Kumar C. Peristaltic waves: A clinical clue of infantile hypertrophic pyloric stenosis. Indian Pediatr Case Rep [serial online] 2021 [cited 2021 Sep 26];1:206. Available from: http://www.ipcares.org/text.asp?2021/1/3/206/325087

A 6-week-old male child was admitted with recurrent episodes of vomiting after breastfeeding for 10 days. Initially, the vomiting was nonbilious but had recently become projectile. There was no history of fever, diarrhea, jaundice, or lethargy. Despite being always hungry and vigorously suckling when breastfed, there was a significant history of loss of weight since birth (weight 3270 g). Urine output was normal. At admission, weight was 2515 g. The baby was severely dehydrated. Peristaltic waves moving from the left to the right side of the upper abdomen were observed [Figure 1] and Video 1][Additional file 1]. However, an olive-shaped mass was not palpable in the abdominal midline. Hypochloremic, hyponatremic, hypokalemic metabolic alkalosis was found, with elevated urea and creatinine levels. Dehydration correction was started. Infantile hypertrophic pyloric stenosis (IHPS) was suspected which was confirmed when an abdominal ultrasonogram detected a thickened pylorus muscle with elongated pyloric canal. The baby underwent laparoscopic pyloromyotomy successfully and has been thriving in follow-up.
Figure 1: A wavelike elevation observed on the left upper abdomen. The peristaltic wave moved to the right side

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IHPS is the most common cause of gastric outlet obstruction in infancy and one of the most common causes of surgery in a young infant.[1] The classic triad described in this condition is visible peristalsis, palpable pyloric mass, and projectile vomiting. However, their simultaneous occurrence is rarely seen, as in this case.[2] A palpable mass is seen in 60%–80% of cases. Peristaltic wave is because of attempted forceful movement of the gastric contents past the narrow pyloric canal and is an important clue for early diagnosis.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given consent for images and other clinical information to be reported in the journal. The guardian understands that the names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Otjen JP, Iyer RS, Phillips GS, et al. Usual and unusual causes of pediatric gastric outlet obstruction. Pediatr Radiol 2012;42:728-37.  Back to cited text no. 1
    
2.
Gotley LM, Blanch A, Kimble R, et al. Pyloric stenosis: A retrospective study of an Australian population. Emerg Med Australas 2009;21:407-13.  Back to cited text no. 2
    
3.
White MC, Langer JC, Don S, et al. Sensitivity and cost minimization analysis of radiology versus olive palpation for the diagnosis of hypertrophic pyloric stenosis. J Pediatr Surg 1998;33:913-7.  Back to cited text no. 3
    


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