Infantile Hypertrophic Pyloric Stenosis (IHPS) in Infants and Children: Evidence-Based Emergency Imaging

  • Marta Hernanz-SchulmanEmail author
Part of the Evidence-Based Imaging book series (Evidence-Based Imag.)


Infantile hypertrophic pyloric stenosis (IHPS) is a condition affecting young infants in which there is gastric outlet obstruction secondary to hypertrophy and failure of relaxation of the muscular wall and thickening of the mucosa of the antropyloric portion of the stomach. Although the etiology of IHPS remains unknown, its diagnosis and treatment are highly successful. Physical examination and imaging with ultrasound are the most important diagnostic considerations, while treatment with pyloromyotomy is typically curative. The purpose of this review is to consider the etiological hypotheses and epidemiology of the condition and to examine the evidence supporting the various diagnostic investigations.


Pylorus, stenosis Infants, gastrointestinal tract Radiography, infants and children Ultrasound, infants and children Vomiting, infants Vomiting, infants non-bilious Emergency imaging Evidence-based imaging 



The author would like to acknowledge the work of Drs. Barry R. Berch and Wallace W. Neblett III, her coauthors on two previous chapters (both titled Imaging of Infantile Hypertrophic Pyloric Stenosis by Marta Hernanz-Schulman, Barry R. Berch, and Wallace W. Neblett III, one in Medina LS et al., eds: Evidence-Based Imaging: Improving the Quality of Imaging in Patient Care (2011), and the other in Medina LS et al., eds: Evidence-Based Imaging in Pediatrics: Improving the Quality of Imaging in Patient Care (2010), both published by Springer Science), which served as a starting point for this current chapter.


  1. 1.
    Hernanz-Schulman M, et al. J Ultrasound Med. 1995;14(4):283–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Hernanz-Schulman M, et al. AJR. 2001;177(4):843–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Kobayashi H, O’Briain D, Puri P, et al. J Ped Surg. 1994;29:651–4.CrossRefGoogle Scholar
  4. 4.
    Kusafuka T, Puri P. Pediatr Surg Int. 1997;12(8):576–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Langer JC, Berezin I, Daniel EE. J Pediatr Surg. 1995;30(11):1535–43.PubMedCrossRefGoogle Scholar
  6. 6.
    Malmfors G, Sundler F. J Pediatr Surg. 1986;21(4):303–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Ohshiro K, Puri P. J Pediatr Surg. 1998;33(2):378–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Ohshiro K, Puri P. Pediatr Surg Int. 1998;13:253–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Okazaki T, et al. J Ped Surg. 1994;29:655–8.CrossRefGoogle Scholar
  10. 10.
    Vanderwinden J, et al. NEJM. 1992;327:511–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Vanderwinden JM, et al. Gastroenterology. 1996;111(2):279–88.PubMedCrossRefGoogle Scholar
  12. 12.
    Wattchow D, et al. Gastroenterology. 1987;92:443–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Capon F, et al. Am J Hum Genet. 2006;79(2):378–82.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Everett KV, et al. EJHG. 2008;16(9):1151–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Everett KV, et al. Am J Hum Genet. 2008;82(3):756–62.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Everett KV, Chung EM. J Hum Genet. 2013;58(4):236–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Feenstra B, et al. Nat Genet. 2012;44(3):334–7.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Callahan MJ, et al. Pediatr Radiol. 1999;29(10):748–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Holland AJ, et al. Pediatr Surg Int. 1997;12(7):497–500.PubMedCrossRefGoogle Scholar
  20. 20.
    Dodge JA, Karim AA. Gut. 1976;17(4):280–4.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Rollins MD, et al. Arch Dis Child. 1989;64(1):138–9.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Vanderwinden JM, et al. J Pediatr Surg. 1996;31(11):1530–4.PubMedCrossRefGoogle Scholar
  23. 23.
    Bokay J, et al. Pediatr Surg Int. 2004;20(5):343–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Carter CO. Br Med Bull. 1976;32(1):21–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Krogh C, et al. Pediatrics. 2012;130(4):e943–9.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Krogh C, et al. Am J Epidemiol. 2012;176(1):24–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Zamakhshary MF, et al. Pediatr Surg Int. 2011;27(7):689–93.PubMedCrossRefGoogle Scholar
  28. 28.
    Lisonkova S, Joseph KS. Matern Child Health J. 2014;18(7):1721–7.PubMedCrossRefGoogle Scholar
  29. 29.
    MacMahon B. Epidemiology. 2006;17(2):195–201.PubMedCrossRefGoogle Scholar
  30. 30.
    Krogh C, et al. Pediatrics. 2011;127(1):e197–201.PubMedCrossRefGoogle Scholar
  31. 31.
    White MC, et al. J Pediatr Surg. 1998;33(6):913–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Piroutek MJ, et al. Clin Pediatr. 2012;51(3):214–8.CrossRefGoogle Scholar
  33. 33.
    Touloukian RJ, Higgins E. J Pediatr Surg. 1983;18(4):394–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Breaux CW, Hood JS, Georgeson KE. J Pediatr Surg. 1989;24(12):1250–2.PubMedCrossRefGoogle Scholar
  35. 35.
    Glatstein M, et al. Clin Pediatr. 2011;50(3):192–5.CrossRefGoogle Scholar
  36. 36.
    Teele RL, Smith EH. NEJM. 1977;296(20):1149–50.PubMedCrossRefGoogle Scholar
  37. 37.
    Grosfeld JL, Coran AG, Fonkalsrud EW, editors. Pediatric surgery. 6th ed. Philadelphia: Mosby Elsevier; 2006.Google Scholar
  38. 38.
    Godbole P, et al. Arch Dis Child. 1996;75(4):335–7.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Macdessi J, Oates R. BMJ. 1993;306:553–5.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Hefke H. Radiology. 1944;43:267–71.CrossRefGoogle Scholar
  41. 41.
    Currarino G. Radiology. 1964;83:873–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Shuman FI, Darling DB, Fisher JH. J Pediatr. 1967;71(1):70–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Hernanz-Schulman M, et al. Radiology. 1994;193(3):771–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Stunden RJ, LeQuesne GW, Little KE. Pediatr Radiol. 1986;16(3):200–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Blumhagen JD, et al. AJR. 1988;150(6):1367–70.PubMedCrossRefGoogle Scholar
  46. 46.
    Graif M, et al. Pediatr Radiol. 1984;14(1):14–7.PubMedCrossRefGoogle Scholar
  47. 47.
    O’Keeffe FN, et al. Radiology. 1991;178(3):827–30.PubMedCrossRefGoogle Scholar
  48. 48.
    Leaphart CL, et al. J Pediatr Surg. 2008;43(6):998–1001.PubMedCrossRefGoogle Scholar
  49. 49.
    Iqbal CW, et al. J Pediatr Surg. 2012;47(8):1542–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Keckler SJ, et al. Eur J Pediatr Surg. 2008;18(3):168–70.PubMedCrossRefGoogle Scholar
  51. 51.
    Hernanz-Schulman M. IRadiology. 2003;227(2):319–31.Google Scholar
  52. 52.
    Freund H, et al. Lancet. 1976;1(7982):473.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Diagnostic ImagingMonroe Carell Jr. Children’s Hospital at Vanderbilt UniversityNashvilleUSA

Personalised recommendations