Ihps

For specialist surgeon

1. LT COL SM SHAHADAT HOSSAIN MCPS,FCPS(surgery)FCPS(Thoracic surgery ) Adv Trg on Thoracoscopy CNUH, South Korea INFANTILE HYPERTROPHIC PYLORIC STENOSIS (IHPS)

2. IHPS Most common cause of intestinal obstruction in infancy. It is due to hypertrophy and hyperplasia of the muscular layers of the pylorus.

3. Epidemiology Age: 2 and 8 weeks and rarely 13 weeks. Incidence: 1:300. Male : female:4:1 . Genetic predisposition.

4. Symptoms Non-bilious projectile vomiting. Test feeding; visible gastric peristalsis is seen in the upper abdomen.

5. On Examination Firm , non-tender, and mobile hard mass 1-2 cm as an "olive ,“ in the epigastrium. Dehydration. Malnutrition.

6. Investigations CBC, blood grouping. Electrolytes – Hypochloremia , hypokalemia, hyponatremia . Urea, creatinine.

7. Investigations Ultrasound of abdomen: T hickened pyloric muscle; 3cm or more and length of pylorus greater than 13mm.

8. TREATMENT Pre-operative preparation: NPO. Nasogastric suction; 8–10 Fr. Correction of dehydration and alkalosis is corrected by giving 150–180 mL/kg/day of 0.9% saline with 0.15% KCl in 5% glucose.

9. Ramstedt’s pyloromyotomy By a laparoscopic or open supraumbilical incision under GA. STEPS: Longitudinal incision is made in the pylorus. Hypertrophied muscle is cut along the whole length until the mucosa bulges out. If the mucosa is injured, it is sutured horizontally using interrupted vicryl .

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12. Post operative NPO for 24 hrs. Nasogastric suction . IV fluid150–180 mL/kg/day of 0.9% saline with 0.15% KCl in 5% glucose . Antibiotics. Analgesic.

13. COMPLICATIONS Peritonitis from perforation through the mucosa. Haemorrhage . Residual stenosis. Wound infection. Wound dehiscence.

14. CONSENT INFORMATION PROCEDURE: A cut into an abnormal muscle mass at the end of the stomach, to allow normal stomach emptying. ANAESTHETIC: RISKS OF THIS PROCEDURE:

15. CONSENT INFORMATION RISKS OF THIS PROCEDURE: Rarely when the muscle is divided, the stomach lining may be holed Damage to the bowel, which may cause leakage of bowel fluid. Deep bleeding in the abdomen. Infections such as pus collections in the abdominal cavity.

16. CONSENT INFORMATION RISKS OF THIS PROCEDURE: The bowel movement may be paralysed or blocked after surgery. A weakness in the wound. The baby may continue to vomit for some days after the operation. Rarely further surgery may be necessary to divide more muscle. Adhesions may form and cause bowel blockage.

17. CONSENT INFORMATION PARENT CONSENT: I acknowledge that: The doctor has explained my child's medical condition and the proposed procedure. I understand the risks.

18. CONSENT INFORMATION DOCTOR'S STATEMENT: I have explained to the parent: - the child's condition - need for treatment - the procedure and the risks - relevant treatment options and their risks. Name of Doctor Designation Signature Date

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