0:00

So this next patient is a little bit of an older patient,

0:03

but you might encounter this in the neonatal intensive care

0:06

unit as you have patients who are there for long periods

0:08

of time just feeding and growing.

0:10

So this patient presented at seven weeks of life

0:13

with poor weight gain, projectile vomiting.

0:16

It was non villous vomiting.

0:18

And as the cherry on top of this Sunday of history, um,

0:22

this patient's had a family history

0:24

of hypertrophic pori stenosis.

0:26

So of course the first line, um,

0:27

imaging when you have a clinical concern

0:29

for pric stenosis is ultrasound.

0:32

Um, sometimes you don't even have to measure the pori.

0:35

It is so absolutely thick.

0:38

So, um, on this single wall thickness,

0:40

we are at just about four millimeters.

0:42

When you look at the length of this pric channel here,

0:46

it is two centimeters in length.

0:47

So that is well above the upper limit of normal.

0:50

So in order to diagnose pric stenosis, that ultrasound,

0:53

we want a single muscle thickness

0:55

of four millimeters or larger.

0:57

And then we want a Pylori channel length of up

0:59

to 1.5 centimeters.

1:01

So this is compatible with hyper hypertrophic pric stenosis.

1:05

We don't stop there because you can see pori spasm as well.

1:09

So we will, um, wait and repeat imaging of the patients.

1:13

Sometimes the ED

1:15

or the NICU will do a, like feeding challenge

1:18

of these infants where they want to like watch the patient,

1:21

um, uh, have an episode of emesis, for example.

1:25

Um, but at ultrasound we, we can do basically what we used

1:28

to do with upper GI at the, at the olden days

1:30

where we will look for passage or lack thereof.

1:35

Um, no passage of contents through that pyloric channel.

1:39

So this is showing you this like mushrooming

1:41

of hypertrophied, musculus propria, um,

1:44

pylori extending into the gastric antrum.

1:48

And we're looking at pi, uh, uh, peristalsis

1:52

and movement of milk content or, uh, water

1:55

or whatever this patient ingested in the stomach.

1:58

But we never see any contents, no gas bubbles,

2:02

no fluid extending through this pori channel.

2:04

Um, so this confirms our suspicion

2:06

of hypertrophic pyloric stenosis at ultrasound.

2:09

And so this patient will undergo myotomy.