Xiao Bao (pseudonym) is a small child who is only 35 days old, 2 weeks after birth began to vomit, the beginning was not serious, the vomiting gradually aggravated in the past half a month, every time after eating milk to vomit, and it is squirting, vomiting more, watching Xiao Bao gradually lose weight, the number of bowel movements is also less, Xiao Bao's parents look very distressed... They took Xiaobao to a number of hospitals, and after oral medication was conservatively treated, there was no significant improvement. In the past 2 days, there was frequent vomiting and poor mental response, and at 20:35 on the evening of October 7, Xiao Bao's parents held the child for only 35 days and rushed to the pediatric surgery department of Changzhi Maternal and Child Health Hospital.
Congenital hypertrophic pyloric stenosis
The doctor on duty of the hospital considered that congenital hypertrophic pyloric stenosis was possible after careful physical examination, careful inquiry of medical history and abdominal color ultrasound examination. Poor Xiao Bao, due to long-term vomiting, has dehydration and electrolyte disorders, and the doctor on duty immediately gave him admission to the hospital. After actively administering to correct the water electrolyte disorder and improve the preoperative examination, Xiao Bao was clearly diagnosed as: congenital hypertrophic pyloric stenosis on the 2nd day after the upper gastrointestinal angiography.
Before the operation, Song Jin, director of pediatric surgery of the hospital, led everyone to conduct a full preoperative discussion, assessed the risks and complications that may occur during and after Xiaobao's surgery, and formulated a detailed diagnosis and treatment plan. Finally, considering the child's young age and poor resistance, it was decided to give pediatric laparoscopic minimally invasive surgery, which can be completed by performing only 5 mm incisions in the umbilical cord and two 3 mm incisions around the umbilicus, which has the advantages of short operation time, small surgical trauma, fast postoperative recovery, etc. Sugar water can be eaten 6 hours after surgery, and breast milk or formula can be eaten on the 2nd day.
The operation went very smoothly! On the morning of October 11, under general anesthesia, Xiao Bao was subjected to laparoscopic minimally invasive surgery, and during the operation, the pylorus was olive-shaped and thick, pale, about 2.0 cm long, and hard. The pyloric ring muscle incision was given during the operation, and the operation went very smoothly! After the operation, Xiaobao recovered very well, and has been able to eat normally at present, and there is no vomiting again. Xiao Bao's parents were finally relieved, and the smile returned to their faces...
Understanding "Congenital Hypertrophic Pyloric Stenosis"
Congenital hypertrophic pyloric stenosis is a mechanical obstruction caused by hypertrophy and hyperplasia of the pyloric ring muscle, resulting in pyloric lumen stenosis.
Primary symptoms
1. Vomiting: Vomiting usually occurs 2 to 3 weeks after birth, initially only milk return, followed by squirting vomiting. At first, there is occasional vomiting, and as the obstruction worsens, it is vomited almost every time after feeding, the vomit is mucus or milk, and if it persists in the stomach for a long time, it spits out curd, without bile. In rare cases due to irritating gastritis, vomit contains fresh or degenerated blood.
2. Weight loss, decreased bowel movements: due to insufficient intake of milk and water, the weight does not increase at first, followed by a rapid decline, the amount of urine is significantly reduced, and the stool is defecated once a few days, the amount is small and hard. Vomiting and loss of a large amount of stomach acid in the early stage of the disease can cause alkalosis, shallow and slow breathing, and symptoms such as laryngeal spasm and hand and foot twitching.
3. Concomitant jaundice: indirect elevation of bilirubin is predominant. May be due to repeated vomiting and inadequate caloric intake leading to low glucuronidate transferase activity in the liver. Extrahepatic obstructive jaundice may also be caused by a pyloric mass or dilated stomach compression of the bile ducts. Once the pyloric obstruction is lifted, the jaundice resolves within 3 to 5 days.
How to diagnose
Based on typical clinical manifestations, the diagnosis is confirmed by seeing three main signs of gastric peristalsis waves, pyloric mass, and ejective vomiting. One of the most reliable diagnostic bases is real-time ultrasonography or barium testing to help confirm the diagnosis. Diagnostic criteria for pyloric hypertrophy are 16 mm pyloric duct length >, pyloric muscle thickness ≥ 4 mm, pyloric tube diameter > 14 mm. Barium testing is diagnostic with pyloric line signs.
How to treat
Once the disease is diagnosed, it requires surgical treatment. Pyloritomy is the best treatment, with a short course of treatment and good results. Preparation must be made 24 to 48 hours before surgery, dehydration and electrolyte abnormalities are corrected, and potassium salts are supplemented. Malnourished people are given intravenous nutrition to improve the general condition. The Department of Pediatric Surgery of Changzhi Maternal and Child Health Hospital adopts neonatal laparoscopic minimally invasive surgery, and has cured dozens of children with a good prognosis, followed up for 3 months, and significant weight gain.
Tips from pediatric surgeons
Every little baby is an angel of parents, reminding parents that professional things are left to professional people to do, which is the best care for children.
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Pediatric Surgery Team!
Founded in 1999, the Pediatric Surgery Department of Changzhi Maternal and Child Health Hospital has an annual outpatient volume of more than 5,000 person-times and an annual operation volume of nearly 1,000 times. After more than 10 years of development, it has formed a discipline with a solid foundation, a sound talent echelon, strong technical force, advanced instruments and equipment, and coordinated development of medical education and research. In the Changzhi area, pediatric laparoscopic surgery was the first to be carried out, filling the gap in the laparoscopy of pediatric surgery in our city. Pediatric Surgery is the only pediatric surgery department in the city, taking the lead in carrying out laparoscopic surgery under general anesthesia. It is divided into three groups: pediatric general surgery, pediatric urology and neonatal surgery, and day surgery treatment has been carried out for some pediatric surgical diseases. As the only department in Changzhi area to diagnose and treat pediatric congenital structural deformities assistance project, it undertakes the diagnosis of physical disability of disabled children aged 0-6 in Changzhi area.
General practitioners will provide assistance to children and parents who come to the clinic with high-quality advanced technology and warm and thoughtful service.
(Source: Changzhi Maternal and Child Health Hospital)
(Editor-in-Charge: Zhang Wenwei)