Ahmed Nasr1, Sigmund H Ein. 1. The Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Abstract
PURPOSE: Postoperative vomiting in newborns is a common finding usually attributed to the original surgery. We report 10 newborns whose postoperative course was complicated by pyloric stenosis. METHODS: We reviewed the charts of all newborns who had pyloric stenosis diagnosed after a major abdominothoracic operation over the past 30 years (1973-2003) at a single children's hospital. RESULTS: Ten cases of pyloric stenosis were diagnosed in postoperative newborns (esophageal atresia [3], small bowel atresia [2], diaphragmatic hernia, fetus-in-fetu, imperforate anus, lung biopsy, malrotation [1]). Their mean gestational age was 36 weeks, birth weight was 3.2 kg, and age at newborn operation was 2 days. Their postoperative feeds started on the sixth day (mean), and the pyloric stenosis vomiting started on the 14th day. It took a mean of 12 days to make the diagnosis of pyloric stenosis, and this was done entirely by diagnostic imaging. Mean age at pyloromyotomy was 3 1/2 weeks. A new incision was used in 7 patients. Postoperative feedings started on the first day; all did well. There were 3 complications (bowel obstruction), all requiring operation. CONCLUSION: Unfortunately, this review offers no specific insight or novel advice to help the readership think about the diagnosis in such a postoperative setting.
PURPOSE:Postoperative vomiting in newborns is a common finding usually attributed to the original surgery. We report 10 newborns whose postoperative course was complicated by pyloric stenosis. METHODS: We reviewed the charts of all newborns who had pyloric stenosis diagnosed after a major abdominothoracic operation over the past 30 years (1973-2003) at a single children's hospital. RESULTS: Ten cases of pyloric stenosis were diagnosed in postoperative newborns (esophageal atresia [3], small bowel atresia [2], diaphragmatic hernia, fetus-in-fetu, imperforate anus, lung biopsy, malrotation [1]). Their mean gestational age was 36 weeks, birth weight was 3.2 kg, and age at newborn operation was 2 days. Their postoperative feeds started on the sixth day (mean), and the pyloric stenosis vomiting started on the 14th day. It took a mean of 12 days to make the diagnosis of pyloric stenosis, and this was done entirely by diagnostic imaging. Mean age at pyloromyotomy was 3 1/2 weeks. A new incision was used in 7 patients. Postoperative feedings started on the first day; all did well. There were 3 complications (bowel obstruction), all requiring operation. CONCLUSION: Unfortunately, this review offers no specific insight or novel advice to help the readership think about the diagnosis in such a postoperative setting.