|LETTER TO EDITOR
|Year : 2018 | Volume
| Issue : 4 | Page : 214
Infantile hypertrophic pyloric stenosis and bilious vomiting: An unusual presentation
Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
|Date of Web Publication||3-Dec-2018|
Prof. Mahmood Dhahir Al-Mendalawi
P. O. Box 55302, Baghdad Post Office, Baghdad
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Al-Mendalawi MD. Infantile hypertrophic pyloric stenosis and bilious vomiting: An unusual presentation. J Clin Sci 2018;15:214
I read with interest the case report by Seyi-Olajide et al. on the 11-day-old neonate with infantile hypertrophic pyloric stenosis (IHPS) and bilious vomiting (BV). The authors mentioned two plausible explanations for the rare occurrence of BV in neonates with IHPS, namely early presentation and that BV could be possible through a thickened but not fully obstructed pyloric channel. I presume that the following explanation might be additionally contributory. The authors addressed that intraoperatively, there was no evidence of malrotation or bowel stenosis. The stomach was mildly dilated, and a pyloric mass was found necessitating a Ramstedt's pyloromyotomy. It is noteworthy that to firm diagnosis of IHPS, the histologic demonstration of hypertrophy and hyperplasia of the inner circular muscle of the pylorus on intraoperative antral biopsy is needed. Regrettably, that biopsy was not contemplated in the studied patient. This point is important to be considered as the histology of the prepyloric mucosal biopsy specimens in some cases of IHPS-associated BV was found to include nonspecific inflammation with increased fibrous tissue of the mucosa. It was postulated that pyloric mucosal inflammation, the pathogenesis of which remained unclear, could be the cause of pyloric narrowing leading to BV.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Seyi-Olajide JO, Ladipo-Ajayi OA, Ademuyiwa AO, Elebute OA, Alakaloko FM, Bode CO. Infantile hypertrophic pyloric stenosis and bilious vomiting: An unusual presentation. J Clin Sci 2017;14:207-8. [Full text]
Peters B, Oomen MW, Bakx R, Benninga MA. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol 2014;8:533-41.
Kato S, Konnai I, Harada Y, Komatsu K, Nakagawa H. Pyloric narrowing with increased fibrous tissue of the mucosa in an infant. Tohoku J Exp Med 1991;163:233-8.