Infantile Hypertrophic Pyloric Stenosis Treated with Intravenous Atropine Sulfate

Purpose : The pharmacologic effect of atropine on HPS can be considered to control pyloric muscle spasm. Therefore, we studied the effects of intravenous atropine sulfate on the clinical course of HPS, and periodically observed the ultrasonographic appearance of the pyloric muscles after atropine treatment. Methods : From April 1998 to May 1999, 14 infants who were diagnosed with HPS were treated with intravenous atropine sulfate. Intravenous atropine sulfate was administered at an initial dose of 0.04mg/kg/day, which was divided into 8 equal doses. The daily dose was increased by 0.01 mg/kg/day until vomiting was controlled for an entire day while infants received unrestricted oral feeding. Ultrasonographic examinations were performed during hospitalization and repeated at least every 2 months until normalization of pyloric muscles was confirmed. Results : Intravenous atropine was effective in 12 of 14 infants with HPS and the conditions of 9 of them improved. Two infants who were not free from vomiting despite a week of intravenous atropine sulfate treatment underwent pyloromyotomy. A series of ultrasonographic examinations were done after vomiting had improved with intravenous atropine sulfate. The ultrasonographic findings showed good passage of gastric contents through pyloric canals despite thickening of the pyloric muscles. Conclusion : Intravenous administration of atropine sulfate is an effective therapy for HPS and can be an alternative to pyloromyotomy. (J Korean Pediatr Soc 2000;43:763-768)

[1]  K. Broadley,et al.  Muscarinic Receptor Agonists and Antagonists , 2001, Molecules : A Journal of Synthetic Chemistry and Natural Product Chemistry.

[2]  E. Nishijima,et al.  Successful endoscopic balloon dilatation for hypertrophic pyloric stenosis. , 1996, Journal of pediatric surgery.

[3]  M. Mino,et al.  Management and ultrasonographic appearance of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate. , 1996, Journal of pediatric gastroenterology and nutrition.

[4]  J. Pedersen,et al.  Pyloric Size in Normal Infants and in Infants Suspected of Having Hypertrophic Pyloric Stenosis , 1995, Acta radiologica.

[5]  A. Yamataka,et al.  Abnormal distribution of nerve terminals in infantile hypertrophic pyloric stenosis. , 1994, Journal of pediatric surgery.

[6]  D. O’Briain,et al.  Selective reduction in intramuscular nerve supporting cells in infantile hypertrophic pyloric stenosis. , 1994, Journal of pediatric surgery.

[7]  S. Schiffmann,et al.  Nitric oxide synthase activity in infantile hypertrophic pyloric stenosis. , 1992, The New England journal of medicine.

[8]  P. Swift,et al.  Modern management of pyloric stenosis--must it always be surgical? , 1991, Archives of disease in childhood.

[9]  C. J. Anders,et al.  Audit of results of operations for infantile pyloric stenosis in a district general hospital. , 1991, Archives of disease in childhood.

[10]  P. Tam,et al.  NON-SURGICAL TREATMENT FOR PYLORIC STENOSIS , 1989, The Lancet.

[11]  M. Shields,et al.  Pyloric stenosis: congenital or acquired? , 1989, Archives of disease in childhood.

[12]  G. Steiner,et al.  What happens to the pylorus after pyloromyotomy? , 1988, Archives of disease in childhood.

[13]  A. Mackersie,et al.  Recent results of treatment of infantile hypertrophic pyloric stenosis. , 1988, Archives of disease in childhood.

[14]  U. Klotz,et al.  Pharmacokinetic implications for the clinical use of atropine, scopolamine and glycopyrrolate , 1988, Acta anaesthesiologica Scandinavica.

[15]  P. Tam,et al.  Pyloric function five to eleven years after Ramstedt's pyloromyotomy. , 1985, Journal of pediatric surgery.

[16]  Don A. Wilson,et al.  reliable sonographic diagnosis of hypertrophic pyloric stenosis , 1984, Journal of clinical ultrasound : JCU.

[17]  H. G. Noble,et al.  Muscle thickness in hypertrophic pyloric stenosis: sonographic determination. , 1983, AJR. American journal of roentgenology.

[18]  M. Michowitz,et al.  Congenital hypertrophic pyloric stenosis: a long-term follow-up of 41 cases. , 1980, The American surgeon.

[19]  Van Heerden Ja,et al.  Congenital hypertrophic pyloric stenosis. Surgical experience. , 1975 .

[20]  L. Day.  Medical management of pyloric stenosis. , 1969, JAMA.

[21]  T. Santulli,et al.  CONGENITAL PYLORIC STENOSIS: A CONTROLLED EVALUATION OF MEDICAL TREATMENT UTILIZING METHYL-SCOPOLAMINE-NITRATE. , 1965, The Journal of pediatrics.

[22]  H. Hamilton,et al.  INFANTILE HYPERTROPHIC PYLORIC STENOSIS IN FOUR SIBLINGS. , 1964, American journal of diseases of children.

[23]  N. M. Jacoby.  Pyloric stenosis: selective medical and surgical treatment. A survey of sixteen years' experience. , 1962, Lancet.

[24]  A. Yamataka,et al.  Lack of intestinal pacemaker (C-KIT-positive) cells in infantile hypertrophic pyloric stenosis. , 1996, Journal of pediatric surgery.