[Sonography of hypertrophic pyloric stenosis--attempt at prognostic evaluation based on sonographic criteria].

Clinical and sonographic findings in 27 patients were analysed in a retrospective study in order to find sonographic criteria for the necessity of surgical treatment of infantile hypertrophic pyloric stenosis. Thirteen patients underwent surgical treatment, 14 were cured by conservative management only. Patients did not differ as regards clinical or serological findings when first investigated by means of sonography. On first examination, carried out about three days after the onset of symptoms, most of the patients who necessitated surgical treatment showed 1) a long canal segestorius (greater than 20 mm), 2) a significantly elevated muscle to lumen ratio exceeding 2:1, 3) pathological "target sign" in the medium upper stomach measuring more than 18 mm, 4) no passage of stomach contents to the duodenum on real time sonography examination. However, this constellation of features was also observed in some patients who were treated successfully by conservative management. Thus, although statistically significant differences were found between these two groups of patients, a definitive prospective decision in the individual patient with regard to the necessity of surgical treatment could not be obtained on the basis of the above-mentioned ultrasound signs. Our study suggests that sonographic criteria are helpful in establishing the diagnosis of infantile hypertrophic pyloric stenosis and also in evaluation of the response to therapeutic management, but--at the time of initial investigation--cannot provide accurate prognostic information.