Congenital Hypertrophic Pyloric Stenosis (CHPS)

• Age:6 weeks old
• Gender: Male

Using a high-frequency transducer these findings were noticed :

Regarding measurements of the canal :

 Pyloric muscle wall thickness >3 mm.
 Pyloric transverse diameter >13 mm with pyloric channel closed.
 Elongated pyloric canal >17 mm in length.

Regarding morphological changes :

 Target sign (transverse view).
 Cervix sign (long. View).
 Antral nipple sign (long. view in attached video) : protrusion of the redundant mucosa.

Teaching point:

• Hypertrophic Pyloric Stenosis is defined by thickening of the muscular layer of the pyloric canal with subsequent failure in relaxation resulting in projectile and non-bilious vomiting in the 1^st few months of life (mean peak 3-6 weeks).
• The main diagnostic criterion is a measurement of more than 3mm in thickness of the muscular layer.
• Abnormal elongation of the canal is characterized as greater than 12 mm in length.
• Treatment is surgical with pyloromyotomy after correction of dehydration.

Additional pearls :

• Bilious vomiting means alternative diagnosis.
• Ultrasound examination is the 1^st modality of choice with advantages of detecting abnormal measurements as well as morphological changes of the canal.
• Main DD is pylorospasm (which is transient and the muscle is not hypertrophied & its thickness less than 3mm) .