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Vomiting in infants under the age of 3 months is one of the most common reasons for parents to seek care from their doctor or present to an emergency room. The imaging workup that ensues is dependent on several factors: age at onset, days versus weeks after birth, quality of emesis, bilious or nonbilious vomiting, and the initial findings on plain radiograph, suspected proximal versus distal bowel obstruction. The purpose of these guidelines is to inform the clinician, based on current evidence, what is the next highest yield and most appropriate imaging study to pursue a diagnosis. The goal is rapid and accurate arrival at a plan for treatment, whether surgical or nonsurgical. The following modalities are discussed for each variant of the symptom: plain radiography, fluoroscopic upper gastrointestinal series, fluoroscopic contrast enema, ultrasound of the abdomen, nuclear medicine gastroesophageal reflux scan. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Opioid analgesia is often avoided in infants undergoing pyloromyotomy. Previous studies highlight an association between opioid use and prolonged hospitalization after pyloromyotomy. However, the impact of opioid use on healthcare resource utilization and cost is unknown. We hypothesized that use of opioids after pyloromyotomy is associated with increased resource utilization and costs. A retrospective cohort study was conducted identifying healthy infants aged <6 mo with a diagnosis of pyloric stenosis who underwent pyloromyotomy from 2005 to 2015 among 47 children's hospitals using the Pediatric Health Information System database. Time of opioid exposure was categorized as day of surgery (DOS) alone, postoperative use alone, or combined DOS and postoperative use. Primary outcomes were the standardized unit cost, a proxy for resource utilization, billed charges to the patient/insurer, and hospital costs. A multivariable log-linear mixed-effects model was used to adjust for patient and hospital level factors. Overall, 11,008 infants underwent pyloromyotomy with 2842 (26%) receiving perioperative opioids. Most opioid use was confined to the DOS alone (n = 2,158, 19.6%). Infants who received opioids on DOS and postoperatively exhibited 13% (95% confidence interval [CI]: 7%-20%, P -value <0.001) higher total resource utilization compared with infants who did not receive any opioids. Billed charges were 3% higher (95% CI: 0%-5%, P -value = 0.034) for infants receiving opioids isolated to the postoperative period alone and 6% higher (95% CI: 2%-11%, P -value = 0.004) for infants receiving opioids on the DOS and postoperatively. Postoperative opioid use among infants who underwent pyloromyotomy was associated with increased resource utilization and costs. [ABSTRACT FROM AUTHOR]

Vomiting in infants under the age of 3 months is one of the most common reasons for parents to seek care from their doctor or present to an emergency room. The imaging workup that ensues is dependent on several factors: age at onset, days versus weeks after birth, quality of emesis, bilious or nonbilious vomiting, and the initial findings on plain radiograph, suspected proximal versus distal bowel obstruction. The purpose of these guidelines is to inform the clinician, based on current evidence, what is the next highest yield and most appropriate imaging study to pursue a diagnosis. The goal is rapid and accurate arrival at a plan for treatment, whether surgical or nonsurgical. The following modalities are discussed for each variant of the symptom: plain radiography, fluoroscopic upper gastrointestinal series, fluoroscopic contrast enema, ultrasound of the abdomen, nuclear medicine gastroesophageal reflux scan. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Gastric outlet obstruction secondary to pyloric thickening in adolescents is an extremely rare finding. The condition is caused by a number of benign or malignant etiologies that cause an impediment to gastric emptying. Common and uncommon etiologies as well as the pathogenesis of gastric outlet obstruction are discussed. A case study of gastric outlet obstruction in a 14-year-old male is presented, and the crucial role of sonography in the diagnostic process of his condition is considered. [ABSTRACT FROM AUTHOR]

Introduction:  Infants with hypertrophic pyloric stenosis have gastric outlet obstruction, indicating a pyloromyotomy. To prevent aspiration, a rapid sequence induction (RSI) of anesthesia used to be preferred. However, due to concerns about the side-effects of this technique in infants, a modified RSI with gentle mask ventilation is nowadays mostly used. This research investigates if induction with succinylcholine (classic RSI), cisatracurium (modified RSI), or no neuromuscular blocking agent (NMBA) influences time until extubation and incidence of complications in infants undergoing laparoscopic pyloromyotomy.Materials and Methods:  A retrospective chart review was performed, observing infants undergoing laparoscopic pyloromyotomy in Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, from January 2007 until July 2015. Baseline preoperative data, anesthesia and operation details, time to extubation, and reported complications were gathered. Inclusion criteria were maintenance of anesthesia with sevoflurane and a registered extubation time. Exclusion criteria were the use of combinations of NMBAs, repyloromyotomy, and conversion to laparotomy.Results:  A total of 168 patients were included, of which 21 received succinylcholine, 107 cisatracurium, and 40 no NMBA. Mean duration of surgery was 29 minutes in all three groups; mean duration of anesthesia was 89, 82, and 77 minutes; mean time to extubation was 26, 25, and 23 minutes, respectively, without statistically significant difference. Complications were evenly distributed, no aspiration occurred.Conclusion:  The use of succinylcholine, cisatracurium, or no NMBA at induction of anesthesia in infants undergoing laparoscopic pyloromyotomy had no statistically significant effect on time until extubation and complication rates. A modified RSI seems to be safe and effective in these cases. [ABSTRACT FROM AUTHOR]

Summary: The objective of the study was to describe a modified Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis in foals due to gastric ulceration and assess the short‐ and long‐term outcome of foals receiving the pyloroplasty. Medical records of foals undergoing a modified Heineke–Mikulicz pyloroplasty due to gastric outflow obstruction secondary to a pyloric stenosis were included in this retrospective case series. The pyloroplasty consisted of an oral to aboral full thickness longitudinal incision on the ventral aspect of the pylorus and proximal duodenum, which was sutured closed with 0 polydioxanone in a transverse orientation, thereby, enlarging the pyloric lumen diameter. Long‐term outcome was obtained from medical and race records. The pyloroplasty was successfully performed in three foals with a surgical time of 95–121 min, with immediate return to nursing and hospital stay of 4–14 days. Complications included a small intestinal volvulus and intra‐abdominal adhesions in a foal that did not survive. Another foal had an incisional infection. Two of the three foals went on to race. It was concluded that the pyloroplasty procedure is an acceptable option for the treatment of pyloric stenosis and secondary gastric outflow obstruction due to gastric ulceration. The limited amount of bowel manipulation with no change in intestinal flow, along with the successful outcomes achieved, make this another surgical option available for the correction of pyloric stenosis in foals. [ABSTRACT FROM AUTHOR]

Ultrasonography is an essential tool in pediatric imaging, particularly in the emergency setting. Although ultrasound is often the favored initial modality for abdominal imaging in children, it is highly operator-dependent and therefore prone to misinterpretation which can lead to false positive or negative exams, or even incorrect diagnoses. Conditions discussed in this series include ileocolic intussusception, hypertrophic pyloric stenosis, appendicitis, and ingested foreign bodies. We will review diagnostic criteria, highlight crucial findings, and illustrate commonly-encountered difficulties and mimics. • Ultrasonography is a valuable tool for diagnosing pediatric emergency gastrointestinal conditions • Knowledge of common pitfalls and mimics is essential to avoid misdiagnosis • Conditions discussed include hypertrophic pyloric stenosis, ileocolic intussusception, acute appendicitis, and ingested foreign bodies [ABSTRACT FROM AUTHOR]

Although a laparoscopic approach may be preferred over open procedures for abdominal surgery, there are limited data on the effect of laparoscopic procedures on cerebral and renal oxygenation in neonates and young infants. Here, we evaluated the effect in neonates and infants. In this two-center prospective observational study, we evaluated changes in cerebral and renal regional oxygen saturation (rSO2) in infants during laparoscopic pyloromyotomy. Intraoperative hemodynamic and respiratory parameters and rSO2 were recorded. For the primary outcome, these parameters were compared at incision and at the end of pneumoperitoneum. The study cohort included 25 infants with a mean age of 40 ± 10 days and weight of 4.0 ± 0.6 kg. IAP at the beginning of laparoscopy was 10 ± 2 mmHg (range 7–15 mmHg). Although both cerebral and renal rSO2 decreased from incision compared to the end of laparoscopy, the decrease reached statistical significance only for cerebral rSO2 (81 ± 12 to 76 ± 16, p = 0.033). Similarly, the increase in fractional tissue oxygen extraction (FTOE) was only statistically significant for cerebral FTOE (0.18 ± 0.12 to 0.23 ± 0.16, p = 0.037). No change in hemodynamic or respiratory parameters was found. Although there was a decrease in cerebral rSO2 and increase in cerebral FTOE during pneumoperitoneum, the values did not decrease below those noted before anesthetic induction. [ABSTRACT FROM AUTHOR]

Background: Infantile hypertrophic pyloric stenosis (IHPS) leads to excessive vomiting and metabolic alkalosis, which may subsequently cause apnea. Although it is generally assumed that metabolic derangements should be corrected prior to surgery to prevent apnea, the exact incidence of perioperative apneas in infants with IHPS and the association with metabolic alkalosis are unknown. We performed this systematic review to assess the incidence of apnea in infants with IHPS and to verify the possible association between apnea and metabolic alkalosis. Methods: We searched MEDLINE, Embase, and Cochrane library to identify studies regarding infants with metabolic alkalosis, respiratory problems, and hypertrophic pyloric stenosis. We conducted a descriptive synthesis of the findings of the included studies. Results: Thirteen studies were included for analysis. Six studies described preoperative apnea, three studies described postoperative apnea, and four studies described both. All studies were of low quality or had other research questions. We found an incidence of 27% of preoperative and 0.2%‐16% of postoperative apnea, respectively. None of the studies examined the association between apnea and metabolic alkalosis in infants with IHPS. Conclusions: Infants with IHPS may have a risk to develop perioperative apnea. However, the incidence rates should be interpreted with caution because of the low quality and quantity of the studies. Therefore, further studies are required to determine the incidence of perioperative apnea in infants with IHPS. The precise underlying mechanism of apnea in these infants is still unknown, and the role of metabolic alkalosis should be further evaluated. [ABSTRACT FROM AUTHOR]

Ectopic pancreas is a congenital developmental anomaly that may be caused by embryologic errors. The pathogenetic details of ectopic pancreas remain unclear, but it has gradually been determined to originate at the gene level. DNA errors during embryological development cause ectopic pancreas. Ectopic pancreas is generally asymptomatic and harmless throughout the patient's entire life; in very rare cases, however, it can be symptomatic and harmful, causing pain, fever, bleeding, and other adverse effects. We herein report an unusual case involving a 52-year-old Japanese woman who presented with nausea and vomiting due to inflammation of an ectopic pancreas in the gastric antrum. Ectopic pancreatitis caused severe pyloric stenosis, and she was unable to ingest food or water even after admission to the internal medicine ward. Ectopic pancreatitis is a very rare clinical condition, but clinicians should be cautious of this uncommon disease in patients who develop gastric outlet obstruction without cancer or ulcers. The present case report is clinically significant because surgical treatment (distal partial gastrectomy) relieved the patient's serious distress rapidly and successfully after unsuccessful conservative treatments for acute ectopic pancreatitis. Antrectomy (distal partial gastrectomy) might be useful for ectopic pancreas, especially in case of gastric outlet obstruction due to the ectopic pancreatitis. [ABSTRACT FROM AUTHOR]

The prognosis of locally advanced gastric cancer is poor even if radical gastrectomy with D2 lymphadenectomy is followed by adjuvant chemotherapy. Hence, neoadjuvant chemotherapy is performed to try to improve the prognosis, as it can significantly downstage the tumor and safely improve the R0 resection rate of patients. Herein, we report a case of locally advanced gastric cancer with pancreatic invasion and gastric outlet obstruction that showed a pathological complete response after neoadjuvant chemotherapy with S-1 and oxaliplatin (SOX). A 74-year-old man presented to our hospital with abdominal pain and pyloric stenosis. CT images revealed a cStage IVb, cT4b tumor in the pancreas, cN1, cM0. Therefore, we performed laparoscopic gastrojejunostomy, and the patient's oral intake improved after surgery; we then administered neoadjuvant chemotherapy with SOX on postoperative day 18, without any surgical complications. After 3 courses of neoadjuvant chemotherapy, the patient underwent radical distal gastrectomy, thereby avoiding pancreatoduodenectomy. Histopathological examination of the resected sample revealed no residual cancer cells, indicating a pathological complete response. No recurrence has occurred for 1 year after surgery. Thus, neoadjuvant chemotherapy with SOX can help in tumor downstaging and may be a multipotent option for the treatment of locally advanced gastric cancer, such as cases with the invasion of other organs; this treatment can result in improved curability and avoid overinvasive surgery. [ABSTRACT FROM AUTHOR]

Background: In this study, it was aimed to evaluate the correlation of ultrasonography (USG) parameters (pyloric muscle sizes) with age in term infants diagnosed with infantile hypertrophic pyloric stenosis (IHPS). Materials and Methods: Data of 49 patients diagnosed with IHPS between November 2015 and December 2019 and underwent pyloromyotomy surgery were retrospectively analyzed for this study. The demographic and laboratory data were obtained from the electronic records of the patients. USG parameters such as pyloric muscle thickness (PMT), pyloric diameter (PD), and pyloric muscle length (PML) were measured separately. Term infants were divided into two groups as neonatal (0-28 days) and postneonatal (29-364 days) in order to compare the distribution of USG parameters by age. Infants whose clinical data and USG images were not available together with preterm infants (gestational age <37 weeks) were excluded from the study. Results: Of the 32 patients included in the study, 24 (75%) were male and 8 (25%) were female, and the mean age of the infants was 57.8 days and the median (minimum-maximum) value was 57.5 (9-180) days at the time of admission. In USG examinations, the hypertrophic pyloric muscle was detected in elongated and thick appearance, narrowing the lumen in all patients. There were 15 (46.9%) infants in the neonatal period and 17 (53.1%) in the postneonatal period. In the preoperative measurements, PMT, PD, and PML were high (median value; 4.8, 11.2 and 19.5 mm, respectively). The pyloric measurements of infants in the neonatal and postneonatal period were similar between the two groups, and there was no statistically significant difference (p> 0.05). The correlation between PMT and PML (r = 0.490, p = 0.033) and the correlation between PMT and PD (r = 0.741, p < 0.001) were significant. However, no significant correlation was found between age and pyloric measurements (p> 0.05). When comparing laboratory data, hemoglobin values were significantly lower in infants in the postneonatal period compared to the neonatal group (11±1.5 and 13.7±2.7 g/dL; p < 0.001, respectively). Conclusion: Due to the advantages of USG ionizing radiation used in the diagnosis of IHPS, high sensitivity, and dynamic examination, it is an effective and reliable imaging method that should be preferred first. Although pyloric measurements are valuable for diagnosis, it has been concluded that there is no significant correlation between age and pyloric sizes. [ABSTRACT FROM AUTHOR]

• We have reported the case that underwent laparoscopic total gastrectomy with photodynamic diagnosis based on 5-aminolevulinic acid induced protoporphyrinIX by using PINPOINT®. • PINPOINT®, a brightfield color fluorescence camera, could be used for 5-ALA-PDD. • Administration of 5-ALA through PTEG for a patient with pyloric stenosis was successfully performed. Photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) has been used as a diagnostic procedure for malignant diseases. Dedicated laparoscopes (e.g., an IMAGE1 Camera System®) are used for this procedure. We report a case treated with laparoscopic total gastrectomy with 5-ALA-PDD using the PINPOINT® system. A patient in his 80 s with diffuse-type gastric cancer with pyloric stenosis and ascites was admitted to our hospital. Double percutaneous transesophageal gastrotubing (dPTEG) for both gastric decompression and enteral nutrition and two cycles of preoperative chemotherapy with S-1 plus oxaliplatin were performed preoperatively. Additionally, we preoperatively performed an ex vivo experiment that confirmed that the PINPOINT® system can be used to observed protoporphyrin IX (PpIX) fluorescence. Three hours before surgery, 5-ALA hydrochloride was administered through dPTEG. Observation was performed by PINPOINT®, and Aladuck® was used as an excitation light source. Peritoneal nodules and sampled lymph nodes with red fluorescence were observed by 5-ALA-PDD. Accordingly, we gave up a radical operation and laparoscopic total gastrectomy without systematic lymphadenectomy to improve anemia and release pyloric stenosis was performed. The patient's postoperative course was uneventful. It is possible that the connection with each of the scopes and an exclusive light source (Aladuck®) enable the easy use of 5-ALA-PDD without dedicated laparoscopy. It is expected that 5-ALA-PDD would show the further spread of gastrointestinal cancer if it could be performed with many types of laparoscopes. We found that 5-ALA-PDD-guided surgery can be easily performed in a short time using the PINPOINT® system. [ABSTRACT FROM AUTHOR]

Cystic gastric duplications represent an extremely rare surgical entity. Persistent vomiting is the most common clinical presentation due to its compressive effect on pylorus. Additional confusion is created by their localization mimicking pyloric stenosis. A female infant at 3 months of age was admitted to the clinic for persistent postprandial vomiting and weight loss. Abdominal X ray examination confirmed the presence of aeroliquid levels in the upper abdominal portions. Echosonographic and NMR examination indicated the presence of bilocular cystic formation in the region of the pylorus, near visceral contour of the spleen, with a total diameter of 31 mm. Two partially interconnected cystic formations forming hourglass mass were found during surgery. The complete enucleation was done. Postoperatively, a rapid recovery occurred and the child was discharged home on the 5th day. Pathohistological finding: the lesion corresponds to cystic duplication, with pylorus type mucosa. Peripyloric cysts are an extremely rare clinical entity. Symptomatology is conditioned primarily by a mechanical, compressive effect on the pylorus, which, differentially diagnostically, often mimics pyloric stenosis. Therapy is surgical. [ABSTRACT FROM AUTHOR]

Summary: Background: The clinical findings and outcome associated with chronic severe equine pyloric lesions have not been well described previously. Objectives: To describe the history, clinical signs, endoscopic and ultrasound results, laboratory data, treatment, pathological findings and survival of horses with chronic severe pyloric lesions. Study design: Retrospective case series. Methods: Medical records from horses treated at clinics in Czech Republic and Germany in which chronic severe pyloric lesions were confirmed endoscopically and/or on post‐mortem examination were reviewed. Results: Forty‐seven horses were identified, median age 3 years (range 0.8–16 years). There were 3 geldings, 23 mares and 19 stallions and the majority were Warmbloods (60%). The most common presenting signs were poor body condition (40; 87%), slow eating (39; 83%), recurrent colic (35; 74%) and selective appetite (30; 64%). The most consistent laboratory abnormality was hypoalbuminaemia (10; 36%). Slow gastric emptying was confirmed in 29 individuals during gastroscopy and/or ultrasonography. Endoscopy revealed distal oesophagitis in 9 of 47 horses, and severe equine squamous gastric disease in all cases. Pyloric lesions were depressed, flat or raised fibrinosuppurative pyloric ulcers and were seen in 45 (2 pylori were not seen endoscopically). Thirty‐two cases were treated, with 28 responding well initially. All treated cases received anti‐ulcer medication and four underwent gastrojejunostomy. Clinical signs recurred after medical treatment in at least 11 cases. Only 18 of 44 cases (41%) survived long term (3 were lost to follow‐up). Horses diagnosed at 3 years of age or younger were significantly less likely to survive more than 6 months than older horses (27.8% vs. 72.2%, P<0.001). Main limitations: The study is retrospective, some records were incomplete and case identification was subjective. Conclusions: Chronic severe pyloric lesions can be associated with delayed gastric emptying identified with ultrasonography and/or endoscopy. The prognosis is poor in young horses. [ABSTRACT FROM AUTHOR]

Pyloric stenosis (PS) is rare in the first 2 weeks of life, often leading to delays in diagnosis and treatment. We conducted a case control study to delineate the characteristics of patients with early PS (EPS). In addition, we tested the hypothesis that patients with EPS present with a smaller pylorus than older patients.A database of all patients presenting with PS to a children’s hospital over a 5-year period (2002–2006) was obtained. Each patient admitted during the first 2 weeks of life (subject) was matched to a patient admitted after 4 weeks of age (control), with the same gender, electrolyte status, and treating surgeon. A single pediatric radiologist, blinded to patient age, reviewed all available ultrasounds retrospectively. Demographic, clinical, diagnostic, therapeutic, and outcome data were compared.During the study period, 278 pyloromyotomies were performed for PS. Sixteen patients (5.8%) presented with EPS between 2 and 14 days of life. EPS patients had a higher prevalence of positive family history (31 vs. 0%, P = 0.043), and breast milk feeding (75 vs. 31%, P = 0.045). Sonographic measurements showed a pylorus that was of significantly less length (17.1 ± 0.6 vs. 20.5 ± 0.9 mm, P = 0.006) and muscle thickness (3.5 ± 0.2 vs. 4.9 ± 0.2 mm, P

This article, published in the journal Endoscopy, discusses the endoscopic approach to treating pyloric dysfunction after esophagectomy. Pyloric dysfunctions are common adverse effects of esophagectomies and can significantly impact a patient's quality of life. The study evaluates the efficacy of different endoscopic therapies, such as pneumatic dilation, botulinum toxin injection, G-POEM, and biodegradable stents, in improving symptoms and the Gastric Outlet Obstruction Scoring System (GOOSS) at one month. The results suggest that the endoscopic approach with botulinum toxin and biodegradable stents is effective and safe, although durability may be limited. However, the study's small sample size limits the conclusions that can be drawn. [Extracted from the article]

Recurrent pyloric stenosis poses unique diagnostic challenges, particularly in discerning authentic recurrence from post-pyloromyotomy scarring on ultrasound imaging. A male infant began experiencing projectile non bilious vomiting nine days following birth. Upon initial clinical examination, no evidence of pyloric olive or signs of dehydration were detected. However, an abdominal ultrasound examination unveiled a thickened pyloric wall measuring 4.5 mm, along with a pyloric canal length of 17 mm, indicating the presence of pyloric stenosis. Consequently, an uncomplicated supra-umbilical open pyloromyotomy was performed when the patient was 20 days old. Twenty-three days after being discharged, the patient presented to the emergency for a 24-h history of vomiting after every third bottle. On physical exam, a palpable pyloric olive was discovered. The patient had gained 410 g in 23 days (about 18 g/day). An abdominal ultrasound showed a pyloric muscle length of 21 mm and a muscle thickness of 4.5 mm. A multidisciplinary reunion was conducted between the pediatric gastroenterology and pediatric surgery department deciding to perform a second pyloromyotomy. This was executed through the same supra-umbilical incision. A healed incision scar was found along the complete length of the pyloric muscle on the anterior side. The decision was made to perform a second pyloromyotomy approximately 5 mm more dorsal from the first myotomy. There was a small perforation of the mucosa on the duodenal side which was sutured with a PDS 6/0. The progression unfolded without incident, with an improvement in symptoms and weight gain. Follow-up ultrasounds showed a gradual decrease in the length of the pyloric muscle. Recurrent pyloric stenosis is challenging to differentiate from postoperative edema. Particularly, the pyloric length on ultrasound can help distinguish and indicate whether a second pyloromyotomy should be performed or not. [ABSTRACT FROM AUTHOR]

Cronh's disease (CD) can affect any region from mouth to anus. We described a 23 years old guy who has been diagnosed with CD for 5 years and previously had multiple surgeries due to complications of CD who came in with symptoms of intestinal obstruction. 6 weeks prior, he had a metallic stent inserted to relieve the gastric outlet obstruction (GOO) due to the gastroduodenal involvement of CD. The intestinal obstruction was secondary to the migration of the metallic stent. In this case report, we briefly explained regarding complications of placement of metallic stents and possible ways to prevent it. [ABSTRACT FROM AUTHOR]

The article presents a case of a 13-day-old Hispanic boy who was presented to the pediatric emergency department due to vomiting after every feeding. The infant also exhibits sustained hungriness despite hourly breastfeeding by his mother. The boy has a medical history of coombs positive with up-trending bilirubin. He was diagnosed with hypertrophic pyloric stenosis and successfully underwent laparoscopic pylomyotomy.

We present a rare neurocutaneous genetic disorder where patients develop a combination of cerebral dysgenesis, neuropathy, ichthyosis, and keratoderma, commonly known as CEDNIK syndrome. It is an autosomal recessive inheritance involving the SNAP29 protein, mapped to the 22q11.2 gene. Phenotypic variation is seen with this disease, with clinical manifestation of developmental milestone delays ranging in severity. With only a handful of documented cases, available research, management of the syndrome, and prognosis are not well established. As CEDNIK syndrome has systemic implications, care coordination between specialists is essential in improving patient outcomes. Particularly important is preventing patients from meeting the criteria of failure to thrive, a commonly reported issue. In this case, we present a four-month-old male with a past medical history of pyloric stenosis status/post pyloromyotomy who has failure to thrive, gastroesophageal reflux disease, profound hypotonia, and delayed progression of developmental milestones. Additionally, the case is complicated by idiopathic pyloric stenosis, further contributing to the patient's failure to thrive. We aim to discuss the pathophysiology of this syndrome, explore the timeline of disease progression, as well as compare our case to the current literature., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Potesta et al.)

Background: Definitive surgical care is often delayed in hypertrophic pyloric stenosis (HPS). Our aim is to evaluate the effect modifiable factors in preoperative HPS management have on efficiency of care., Methods: A retrospective review of all patients undergoing pyloromyotomy for HPS at two US children's hospitals between 2008 and 2018 was performed., Results: 406 patients were included in the study. The majority (310, 76 ​%) were adequately resuscitated and ready for surgery upon diagnosis in the ER. However, only 133 patients (43 ​%) had surgery on the day of admission. Patients diagnosed between 12pm and 6pm were more likely to have surgery the next day than those diagnosed before noon (67 ​% vs 33 ​%, p ​< ​.001), which correlated with a longer length of stay (32 vs 47 ​h, p ​< ​.001)., Conclusion: The majority of patients presenting with HPS can safely undergo same day surgery. Delaying surgery due to an afternoon diagnosis is common, and leads to a modifiable increased total length of stay., Competing Interests: Declaration of competing interest All authors declare that they have no pertinent conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Pylorospasm is an elusive diagnosis that can mimic the presentation of pyloric stenosis. There is limited discussion regarding its management in neonates with few case reports describing the use of antispasmodic agents. The following case reviews this management in a unique neonate. A 2-month-old female presented with persistent nonbilious, nonbloody emesis and failure-to-thrive. A thorough workup was performed due to its pronounced persistence while inpatient. Pyloric ultrasounds remained negative for pyloric stenosis; however, an upper gastrointestinal (GI) study was significant for pylorospasm. The workup also revealed hypothyroidism. Antispasmodic therapy with atropine was pursued as she was not a surgical candidate. Patient tolerated IV atropine therapy well with quick resolution of emesis and successfully transitioned to oral atropine therapy, displaying continued weight gain with exclusive oral feeds. This case displays a unique presentation of pylorospasm with successful management utilizing IV and oral atropine therapy in a neonate with failure-to-thrive and concomitant hypothyroidism., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Eosinophilic gastritis is a gastrointestinal disorder characterized by eosinophilic infiltration in the gastric wall. We present a rare case of critical pyloric stenosis secondary to eosinophilic gastritis in a 16-year-old adolescent girl who presented with nausea, vomiting, early satiety, and abdominal pain. Abdominal computed tomography and subsequent esophagogastroduodenoscopy confirmed the anatomical diagnosis, but histological confirmation of the eosinophilic etiology was challenging. After an unsuccessful trial of high-dose systemic corticosteroids, a laparoscopic gastrojejunostomy was performed and long-term immunosuppression with mycophenolate mofetil was commenced., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Specialist surgery in infancy provides challenges for paediatric anaesthetists. There is growing appreciation that the relatively higher rate of severe critical events in infants during the perioperative period requires appropriate competence, experience and resources for the safe conduct of anaesthesia. Both common (inguinal hernias and hypertrophic pyloric stenosis) and less common conditions (tracheo-oesophageal fistula, congenital diaphragmatic hernia, exomphalos, gastroschisis, and congenital lobar emphysema) require a sound understanding of the relevant pathology and the particular issues that may be encountered in these infants. In the last decade there has been a rise in the number of procedures in infancy being performed with a minimally invasive technique and this has a wide range of implications for anaesthesia. [ABSTRACT FROM AUTHOR]

Pyloromyotomy is a common surgical procedure in infants with hypertrophic pyloric stenosis and can be performed with a small laparotomy or laparoscopically. No specific complications have been documented about one of the approaches. We aim to study (severity of) complications of pyloromyotomy and to compare complications of both approaches. Children undergoing pyloromyotomy between 2007 and 2017 were analyzed retrospectively. Complication severity was classified using the Clavien-Dindo classification. We included 474 infants (236 open; 238 laparoscopic). 401 were male (85%) and median (IQR) age was 33 (19) days. There were 83 surgical complications in 71 patients (15.0%). In the open group 45 infants (19.1%) experienced a complication vs. 26 infants in the laparoscopic group (10.5%)(p = 0.013). Severity and quantity of postoperative complications were comparable between both groups. Serosal tears of the stomach (N = 19) and fascial dehiscence (N = 8) occurred only after open pyloromyotomy. Herniation of omentum through a port site occurred only after laparoscopy (N = 6) and required re-intervention in all cases. In conclusion, the surgical complication rate of pyloromyotomy was 15.0%. Serosal tear of the stomach and fascial dehiscence are only present after open pyloromyotomy and omental herniation after laparoscopy respectively. The latter complication is underestimated and requires attention. [ABSTRACT FROM AUTHOR]