RESUMO
Pylorospasm can present with sonographic findings similar to hypertrophic pyloric stenosis. We present a rare case of methicillin-resistant Staphylococcus aureus subhepatic abscess causing pylorospasm in a neonate.
Assuntos
Abscesso Hepático/diagnóstico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estenose Pilórica Hipertrófica/diagnóstico , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Laparotomia , Abscesso Hepático/microbiologia , Abscesso Hepático/terapia , Estenose Pilórica Hipertrófica/microbiologia , Estenose Pilórica Hipertrófica/terapia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/terapiaRESUMO
The aetiology of infantile hypertrophic pyloric stenosis (IHPS) remains unclear. The aim of this study was to test the hypothesis that a common bacterium, Helicobacter pylori (HP) may be implicated in the pathogenesis of IHPS. Thirty-nine consecutive infants with confirmed IHPS had their stool analysed with an enzyme immunoassay for the presence of HP. An age/sex-matched group of infants with unrelated surgical conditions were also tested. No positive results for the presence of HP stool antigen were obtained in the study nor the control group. The results of this study demonstrate no causative link between HP and IHPS. A genetic basis has been implicated for IHPS. However, evidence does exist that IHPS is a condition acquired after birth and that an infective agent may be involved in the pathogenesis. Further studies are required to elucidate perinatal factors that may induce the expression of this condition in a genetically sensitive individual.
Assuntos
Helicobacter pylori/isolamento & purificação , Estenose Pilórica Hipertrófica/microbiologia , Fezes/microbiologia , Feminino , Infecções por Helicobacter/complicações , Humanos , Lactente , MasculinoRESUMO
BACKGROUND: Recently, it has been suggested that Helicobacter pylori might be a cause of some cases of infantile hypertrophic pyloric stenosis (IHPS) in infancy on the basis of its epidemiologic and clinical features. We performed this study to evaluate the possible relationship between IHPS and H. pylori. DESIGN: In consecutive infants with IHPS, we performed upper gastrointestinal endoscopy with biopsy before pyloromyotomy. The endoscopic appearance of the pylorus was noted to validate endoscopic features of IHPS. RESULTS: Sixteen infants, 15 male, 14 white, mean age 42 days, range 21 to 104 days, were studied. The index case had chronic active gastritis on biopsy with organisms suspicious for H. pylori. Four others had chronic active gastritis, six more had focal or mild chronic gastritis, five were normal, and none had H. pylori on histology or immune histochemical staining in selected cases. All patients had negative rapid urease test. Most common endoscopic findings of IHPS were thickened prominent asymmetric pyloric folds and pin-hole pylorus that could not be intubated by the pediatric endoscope. CONCLUSION: H. pylori was not specifically identified in our patients with IHPS. The presence of H. pylori-like organisms in the gastric mucosa in our index case and finding of chronic active gastritis in several others may indicate the possibility of an acquired infectious etiology for IHPS.