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- W2050486045 abstract "An 8-week-old male infant presented to the emergency department with 2 weeks of projectile vomiting. The parents noted he was a well and avid feeder but also noted an “abdominal bulge” that moved from left to right during feedings (Figure 1). Vital signs were normal, except for a weight of 11 lbs (15th percentile). Physical examination revealed dry mucous membranes and a capillary refill greater than 2 seconds. No abdominal hernias or masses were palpated. Serum electrolyte studies revealed a potassium level of 3.3 mEq/L, chloride level of 82 mEq/L, and bicarbonate level of of 38 mEq/L. Ultrasonography was obtained (Figures 2 and 3).Figure 2Pyloric ultrasonography demonstrating a hypoechoic muscle width of 4 to 5 mm on either side of the pyloric canal (pylorus muscle margins indicated by similar-appearing symbols).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Ultrasonography demonstrating pylorus length of 24 mm (pylorus margins indicated by “+” symbol).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Peristaltic abdominal waves associated with infantile hypertrophic pyloric stenosis. Infantile hypertrophic pyloric stenosis is relatively common, occurring in 2 to 5 of every 1,000 births and is caused by the hypertrophy of the antropyloric portion of the stomach.1Krogh C. Fischer T.K. Skotte L. et al.Familial aggregation and heritability of pyloric stenosis.JAMA. 2010; 303: 2393-2399Crossref PubMed Scopus (81) Google Scholar, 2Ranells J.D. Carver J.D. Kirby R.S. Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update.Adv Pediatr. 2011; 58: 195-206Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar The cause is unknown but likely related to genetic and environmental factors.1Krogh C. Fischer T.K. Skotte L. et al.Familial aggregation and heritability of pyloric stenosis.JAMA. 2010; 303: 2393-2399Crossref PubMed Scopus (81) Google Scholar, 3Krogh C. Biggar R.J. Fischer T.K. et al.Bottle-feeding and the risk of pyloric stenosis.Pediatrics. 2012; 130: e943-949Crossref PubMed Scopus (46) Google Scholar Infantile hypertrophic pyloric stenosis usually presents at 4 to 6 weeks of age with nonbilious vomiting often described as “projectile.” If unrecognized, infantile hypertrophic pyloric stenosis can result in weight loss, dehydration, and hypokalemic hypochloremic metabolic alkalosis.4Taylor N.D. Cass D.T. Holland A.J.A. Infantile hypertrophic pyloric stenosis: has anything changed?.J Paediatr Child Health. 2013; 49: 33-37Crossref PubMed Scopus (46) Google Scholar In severe cases such as this, peristaltic waves can be associated with significant weight loss and dehydration.5Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis.Radiology. 2003; 227: 319-331Crossref PubMed Scopus (144) Google Scholar Although challenging to detect and not observed in this patient, palpation of the hypertrophied pylorus or “olive” has a 99% positive predictive value.2Ranells J.D. Carver J.D. Kirby R.S. Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update.Adv Pediatr. 2011; 58: 195-206Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar, 6Chung E. Infantile hypertrophic pyloric stenosis: genes and environment.Arch Dis Child. 2008; 93: 1003-1004Crossref PubMed Scopus (36) Google Scholar Sonographic thickness of the pyloric muscle wall greater than 3 mm or a length greater than 15 mm can confirm the diagnosis.5Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis.Radiology. 2003; 227: 319-331Crossref PubMed Scopus (144) Google Scholar The child underwent pyloromyotomy, did well, and was discharged several days later." @default.
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- W2050486045 title "Infant With Projectile Vomiting" @default.
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- W2050486045 doi "https://doi.org/10.1016/j.annemergmed.2013.06.017" @default.
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