Search Our Scientific Publications & Authors

ANZ J Surg 2022 05 8;92(5):1153-1158. Epub 2022 Apr 8.

Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.

Background: Our aims were to determine if the diagnostic threshold for diagnosing hypertrophic pyloric stenosis (HPS) on ultrasound scan (USS) should be adjusted based on birth weight (BW), current weight (CW), gestational age (GA), chronological age (CA) or corrected gestational age (CGA).

Methods: All patients who underwent either an USS and pyloromyotomy (Group 1) or an USS for possible HPS (Group 2) at our tertiary centre between July 2013 and June 2019 were identified. Ideal threshold values are identified by measuring Youden's Index (J = sensitivity + specificity - 1; higher is better). Read More

Ital J Pediatr 2022 Feb 3;48(1):19. Epub 2022 Feb 3.

Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy.

Background: Contiguous gene deletion syndrome at Xp22.3 resulting in nullisomy in males or Turner syndrome patients typically encompasses the steroid sulfatase gene (STS) and contiguously located other genes expanding the phenotype. In large deletions, that encompass also the Kallmann syndrome 1 gene (KAL1), occasionally infantile hypertrophic pyloric stenosis (IHPS) and congenital anomalies of the kidney and urinary tract (CAKUT) have been reported. Read More

Korean J Radiol 2022 01;23(1):124-138

Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Gastrointestinal (GI) emergencies in neonates and infants encompass from the beginning to the end of the GI tract. Both congenital and acquired conditions can cause various GI emergencies in neonates and infants. Given the overlapping or nonspecific clinical findings of many different neonatal and infantile GI emergencies and the unique characteristics of this age group, appropriate imaging is key to accurate and timely diagnosis while avoiding unnecessary radiation hazard and medical costs. Read More

Pediatr Radiol 2022 03 9;52(3):453-459. Epub 2021 Oct 9.

Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.

Background: The causes of idiopathic ileocolic intussusception are unknown, with infection as the most likely culprit. Recently, social distancing measures were implemented during the coronavirus disease 2019 (COVID-19) pandemic to decrease transmissible infectious diseases, creating an opportune setting to study the role of infection on the pathogenesis of intussusception on a population level.

Objective: To investigate the impact of social distancing on intussusception. Read More

Pediatr Ann 2021 Oct 1;50(10):e419-e423. Epub 2021 Oct 1.

Point-of-care ultrasound (POCUS) for pediatric abdominal symptoms has expanded in both the inpatient and outpatient settings. POCUS may be used to aid in the diagnosis of appendicitis, hypertrophic pyloric stenosis, and intussusception in the pediatric population. This article reviews the benefits of POCUS for the diagnosis of these pediatric pathologies. Read More

ANZ J Surg 2021 11 5;91(11):2507-2513. Epub 2021 Oct 5.

Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Victoria, Australia.

Background: Our aims were to evaluate the ultrasound scan (USS) criteria in diagnosing hypertrophic pyloric stenosis (HPS), determine the best diagnostic threshold values for pyloric muscle thickness (PMT) and pyloric canal length (PCL), and assess the accuracy of flow through the pylorus.

Methods: All patients who underwent pyloromyotomy at our tertiary paediatric surgery centre between July 2013 and June 2019 were identified (Group 1). All patients undergoing an USS to investigate for a possible HPS and did not undergo pyloromyotomy were also identified (Group 2). Read More

Pediatr Emerg Care 2021 Nov;37(11):550-554

From the Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul.

Objectives: This study aimed to investigate the feasibility of point-of-care ultrasound (POCUS) for diagnosing hypertrophic pyloric stenosis (HPS) in the emergency department (ED).

Methods: A retrospective study was conducted in infants aged younger than 90 days who were brought to the ED due to vomiting between January 2015 and December 2019. Of these, infants who were clinically suspected of having HPS and underwent ultrasound were included and categorized into 3 groups: POCUS only, POCUS followed by radiologist-performed ultrasound (RADUS), and RADUS only. Read More

Pediatr Radiol 2021 04 4;51(4):658-668. Epub 2021 Jan 4.

Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin St., Houston, TX, 77030, USA.

Abdominal US is emerging as an alternative to the upper gastrointestinal (GI) series as the preferred diagnostic imaging test for midgut malrotation complicated by volvulus. Unlike the upper GI series, US is free from ionizing radiation, does not require oral contrast agent, and can be performed portably and at times remotely from the interpreting radiologist, expediting diagnosis. Although some institutions do not have a standardized US protocol for midgut volvulus, many routinely use US in the setting of an infant or child with acute abdominal signs or symptoms to evaluate for common conditions such as hypertrophic pyloric stenosis, intussusception, necrotizing enterocolitis and appendicitis. Read More

Clin Radiol 2021 Mar 20;76(3):163-171. Epub 2020 Oct 20.

Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.

Term neonatal bowel obstruction is common, and absence of treatment is potentially catastrophic. There is a relatively narrow differential diagnosis, with causes categorised as either low or high bowel obstruction. The commonest causes of low bowel obstruction include anorectal malformations (ARM), Hirschsprung's disease, ileal atresia, meconium ileus, meconium plug, and colonic atresia. Read More

J Med Ultrason (2001) 2020 10 30;47(4):659-660. Epub 2020 Jul 30.

Department of Pediatric Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.

J Surg Case Rep 2020 Jul 20;2020(7):rjaa232. Epub 2020 Jul 20.

Department of Surgery, Douala Gynaeco-Obstetrical and Paediatric Hospital, Douala, Cameroon.

Gastric outlet obstruction encompasses a broad spectrum of conditions characterized by complete or incomplete obstruction of the distal stomach, which interrupts gastric emptying and prevents the passage of gastric contents beyond the proximal duodenum. Idiopathic hypertrophic pyloric stenosis is the most common cause with an incidence of 1.5-3 per 1000 live births. Read More

Pediatr Int 2020 05;62(5):654-655

Pediatric Department, Faculty of Medicine, Saint Vincent De Paul Hospital, Bar Ilan University, Nazareth, Israel.

Pediatr Radiol 2020 07 27;50(8):1102-1106. Epub 2020 May 27.

Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA, USA.

Background: Hypertrophic pyloric stenosis (HPS) is a common cause of gastric outlet obstruction in young infants. Infants with HPS present with projectile vomiting, sometimes have electrolyte abnormalities and typically undergo pyloromyotomy to alleviate the obstruction. Abdominal US is the gold standard imaging study for diagnosis. Read More

Clin Imaging 2020 Aug 13;64:103-118. Epub 2020 Mar 13.

University of Maryland Medical Center, Department of Diagnostic Radiology and Nuclear Medicine, 22 South Greene Street, Baltimore, MD 21201, United States.

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. Read More

Emerg Med J 2020 Jan;37(1):41-49

Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan

Case presentationA 57-year-old man was in a healthy state until 6 hours before presenting to the emergency department, when he suffered from more than 10 episodes of vomiting after a large meal at lunchtime. On physical examination, vital signs were unremarkable. Tenderness was noted over the epigastrium on palpation. Read More

Pediatr Surg Int 2020 Mar 22;36(3):399-405. Epub 2019 Nov 22.

Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, USA.

Purpose: To retrospectively review imaging planes, number of visible pyloric layers and location of measurements, in infants with suspected (HPS).

Methods: 103 pyloric ultrasound studies for suspected HPS were included. For each study, we recorded whether longitudinal or transverse views were performed, the layers visualized (a schematic was developed for two pediatric radiologists to categorize the interfaces of the anatomic layers a-e) and position of the internal measurement cursor. Read More

Clin J Gastroenterol 2020 Feb 26;13(1):60-65. Epub 2019 Jul 26.

Department of Pathology, Akdeniz University Medical School, 07070, Antalya, Turkey.

Adult hypertrophic pyloric stenosis in the form of focal pyloric hypertrophy is an uncommon but a well-established lesion. In most cases, clinical findings suggest malignancy, and despite advances in imaging techniques, preoperative diagnosis is difficult. Herein, an example of focal pyloric hypertrophy is presented with a review of the literature to emphasize the clinicopathological characteristics of this lesion. Read More

S Afr J Surg 2019 Jun;57(2):65

Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa and Department of Surgery, University of KwaZulu Natal, Durban, South Africa.

Background: Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-born males. It usually presents with projectile, non-bilious vomiting. Late presentation leads to severe dehydration and malnutrition with deranged serum-electrolytes and acid-base imbalance delaying treatment and prolonging hospital stay. Read More

J Pediatr Surg 2019 Nov 18;54(11):2461-2463. Epub 2019 May 18.

46 Whitburn Road, Cleadon, Tyne and Wear SR67QS, United Kingdom. Electronic address:

The age of presentation of reflux symptoms and their self-cure in babies without a sliding hernia parallel those of mild pyloric stenosis of infancy (PS). It is proposed that this is because PS and, at least some cases of reflux, share the same cause-a temporary hold-up at the pyloric sphincter owing to acid provoked hypertrophy of the pyloric sphincter. In support of this theory, the written observations of John Thomson, Pediatrician from Edinburgh, in 1921 and Isabella Forshall, Pediatric Surgeon from Alder Hey Hospital, Liverpool, in 1958 are revisited. Read More

Indian J Pediatr 2019 09 14;86(9):805-816. Epub 2019 Feb 14.

Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India.

The bowel is a challenging abdominal organ to image. The main reason is the variable location, convoluted morphology and motility. A variety of bowel disorders such as congenital, developmental, inflammatory, infectious and neoplastic lesions can affect children and most of them are either unique to this age group or have a distinct clinico-radiological appearance compared to adults. Read More

J Pediatr 2019 May 2;208:292. Epub 2019 Feb 2.

Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.

Am Surg 2018 Sep;84(9):e354-e356

BMJ Case Rep 2018 Sep 21;2018. Epub 2018 Sep 21.

Department of Pediatric Surgery, School of Medicine, Harran University, Sanliurfa, Turkey.

Development of hypertrophic pyloric stenosis (HPS) after a few weeks of repair of an oesophageal atresia (OA) and tracheo-oesophageal fistula (TOF) is a rare condition in early infancy. Although vomiting or feeding intolerance in operated cases of OA+TOF are attributed to oesophageal stricture, gastro-oesophageal reflux and oesophageal dysmotility, it may also be caused by HPS. Herein, we report a newborn infant who had OA and TOF operation on day 2 of life and diagnosed to have HPS at 15th day of age. Read More

BMJ Case Rep 2018 Jul 5;2018. Epub 2018 Jul 5.

Pediatric Gastroenterology, Stony Brook Children's Hospital, Stony Brook, New York, USA.

Hepatic portal venous gas is the presence of gas within the portal vein and its branches. A 4-week-old male infant presented with 1-week history of non-bloody, non-bilious projectile emesis. Examination was significant for an olive-shaped mass in the abdomen. Read More

J Pediatr Surg 2018 Nov 8;53(11):2279-2289. Epub 2018 May 8.

Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202.

Purpose: Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature involving PSPBUS.

Methods: PSPBUS practices reviewed in this paper include central venous catheter placement, physiologic assessment (volume status and echocardiography), hypertrophic pyloric stenosis diagnosis, appendicitis diagnosis, the Focused Assessment with Sonography for Trauma (FAST), thoracic evaluation, and soft tissue infection evaluation. Read More

N Engl J Med 2017 Dec;377(24):e33

Hospital Pediatrico Moctezuma, Mexico City, Mexico

Sci Rep 2017 08 25;7(1):9527. Epub 2017 Aug 25.

Department of Medical Ultrasound, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China.

Congenital Hypertrophic Pyloric Stenosis (CHPS) is a disease condition that is caused as a result of pylorus wall hypertrophy and hyperplasia. In this study, we used color Doppler flow imaging (CDFI) and Doppler artifacts technique to observe the blood flow of hypertrophic pylorus tissue and the dynamic imaging of liquid passing through the pyloric canal in CHPS infants. 65 cases of CHPS infants and 50 infants without CHPS served as control group. Read More

J Matern Fetal Neonatal Med 2018 Oct 27;31(20):2742-2747. Epub 2017 Jul 27.

b Department of Pediatric Surgery , Anhui Provincial Children's Hospital , Hefei , Anhui , China.

Objective: To analyze the clinical and epidemiological features of patients with infantile hypertrophic pyloric stenosis (IHPS) so as to provide scientific evidence for diagnosis and prevention of IHPS.

Methods: We performed a retrospective study of infants with IHPS diagnosed from 2012 to 2015 at Anhui Provincial Children's Hospital. Demographic characteristics and clinical data were collected. Read More

J Pediatr 2017 07;186:40

Tecnologico de Monterrey School of Medicine Monterrey, Nuevo León, Mexico.

J Ultrasound Med 2017 May 10;36(5):1059-1063. Epub 2017 Mar 10.

University of Tennessee/Methodist Healthcare Radiology Residency Program, Memphis, Tennessee, USA.

We describe a new finding, the "excessive bright echoes" sign, for the diagnosis of hypertrophic pyloric stenosis (HPS). Portal venous gas and gastric wall pneumatosis were noted in 4 vomiting infants proven to have HPS. Portal venous gas can be concerning for ischemic bowel. Read More