Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 56

Clinical History:
The patient was a 4 week old male, status post primary repair of esophageal atresia with distal tracheoesophageal fistula, who is in the intensive care unit, who had been vomiting up his G-tube feeds for the last 24 hours.

Clinical Physical Exam:
A palpable olive was present in the mid abdomen.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Pyloric stenosis

Imaging Findings:
An upper GI at 4 weeks of age showed pyloric channel narrowing. An ultrasound examination of the pylorus from later the same day demonstrated marked thickening and elongation of the pylorus.

Images 1, 2, and 3

Images 4, 5, and 6

Imaging Differential Diagnosis:
Pyloric stenosis

Operative Findings:
Two days later the patient underwent a pyloromyotomy on a hypertrophied and thickened pylorus.

Image 7

Image 8

Image 9

Image 10

Pathological Findings:
None

Final Diagnosis:
Hypertrophic Pyloric Stenosis

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
None

References:

• Paediapedia

URL: http://www.virtualpediatrichospital.org/