Document Detail


Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the "olive"?
MedLine Citation:
PMID:  16338303     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND/PURPOSE: Laparoscopic pyloromyotomy has recently gained wide acceptance as the optimum treatment of infantile hypertrophic pyloric stenosis (IHPS). However, medical treatment may be superior to laparoscopic surgery in invasiveness. The efficacy of our regimen of intravenous atropine therapy for IHPS was assessed in comparison with surgical treatment. METHODS: Medical treatment was initially chosen for 52 (61%) of 85 infants with IHPS at our institute between 1996 and 2004. Atropine was given intravenously at 0.01 mg/kg 6 times a day before feeding. When vomiting ceased and the infants were able to ingest 150 mL/kg per day of formula after stepwise increases in the feeding volume, they were given 0.02 mg/kg atropine 6 times a day orally, and the dose was decreased stepwise. RESULTS: Of the 52 patients, 45 (87%) ceased projectile vomiting with treatment using intravenous (median, 7 days) and subsequent oral (median, 44 days) atropine administration. The median hospital stay was 13 days (6-36), and no significant complications were encountered during atropine therapy. The remaining 7 patients required surgery. Of 40 who underwent surgery, 4 had wound infections and 1 with hemophilia had postoperative hemorrhagic shock. The patients who underwent successful atropine therapy had body weights comparable with those who underwent surgery at the age of 1 year. CONCLUSIONS: The high success rate of intravenous atropine therapy for IHPS suggests that this therapy is an effective alternative to pyloromyotomy if the length of the hospital stay and the necessity of continuing oral atropine medication are accepted.
Authors:
Hisayoshi Kawahara; Yuichi Takama; Hideki Yoshida; Hiroshi Nakai; Hiroomi Okuyama; Akio Kubota; Norikazu Yoshimura; Shinobu Ida; Akira Okada
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric surgery     Volume:  40     ISSN:  1531-5037     ISO Abbreviation:  J. Pediatr. Surg.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-12     Completed Date:  2006-07-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0052631     Medline TA:  J Pediatr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1848-51     Citation Subset:  IM    
Affiliation:
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka 594-1101, Japan. kawahara@mch.pref.osaka.jp
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MeSH Terms
Descriptor/Qualifier:
Atropine / administration & dosage,  therapeutic use*
Female
Humans
Infant
Infant, Newborn
Infusions, Intravenous
Laparoscopy
Male
Parasympathomimetics / administration & dosage,  therapeutic use*
Postoperative Complications
Pyloric Stenosis, Hypertrophic / complications,  drug therapy*,  surgery
Retrospective Studies
Treatment Outcome
Vomiting / etiology
Chemical
Reg. No./Substance:
0/Parasympathomimetics; 51-55-8/Atropine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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