案例
一个五周大的足月男婴,过去两周出现进行性食后呕吐。最初诊断为配方奶粉不耐受;多次更改配方奶粉后,病情无缓解。随后,认为其患有胃食管反流。父母继续报告非胆汁性食后呕吐,且已经发展为强劲喷射性呕吐。
其他表现
这种病情甚少发生于早产儿。[2]Gobbi D, Zanon GF, Gamba PG. Pyloric hypertrophic stenosis in the premature child: a clinical case. Pediatr Med Chir. 2000;22:49-50. [in Italian]http://www.ncbi.nlm.nih.gov/pubmed/11387768?tool=bestpractice.com[3]Cosman BC, Sudekum AE, Oakes DD, et al. Pyloric stenosis in a premature infant. J Pediatr Surg. 1992;27:1534-1536.http://www.ncbi.nlm.nih.gov/pubmed/1469564?tool=bestpractice.com然而,一个针对出生于美国军事卫生系统的 1,074,236 名婴儿的回顾性队列研究发现,早产儿的风险比足月儿略高(每 1000 个早产儿中分别有 2.99 个和 2.25 个;相对风险 = 1.33, 95%,置信区间 1.16-1.54)。[4]Stark CM, Rogers PL, Eberly MD, et al. Association of prematurity with the development of infantile hypertrophic pyloric stenosis. Pediatr Res. 2015;78:218-222.http://www.ncbi.nlm.nih.gov/pubmed/25950452?tool=bestpractice.com早产儿幽门狭窄诊断可能颇具挑战性,因为他们出现在比足月儿更晚的实足年龄,但相当于更早的矫正孕龄。此外,早产儿的症状可能不典型的且不那么夸张,用于足月儿的超声标准对其不适用。[5]Stunden RJ, LeQuesne GW, Little K. The improved ultrasound diagnosis of hypertrophic pyloric stenosis. Pediatr Radiol. 1986;16:200-205.http://www.ncbi.nlm.nih.gov/pubmed/3517794?tool=bestpractice.com[6]Blumhagen JD, Maclin L, Krauter D, et al. Sonographic diagnosis of hypertrophic pyloric stenosis. AJR Am J Roentgenol. 1988;150:1367-1370.http://www.ncbi.nlm.nih.gov/pubmed/3285655?tool=bestpractice.com[7]Kovalivker M, Erez I, Shneider N, et al. The value of ultrasound in the diagnosis of congenital hypertrophic pyloric stenosis. Clin Pediatr (Phila). 1993;32:281-283.http://www.ncbi.nlm.nih.gov/pubmed/8324971?tool=bestpractice.com[8]Neilson D, Hollman AS. The ultrasonic diagnosis of infantile hypertrophic pyloric stenosis: technique and accuracy. Clin Radiol. 1994;49:246-247.http://www.ncbi.nlm.nih.gov/pubmed/8162680?tool=bestpractice.com[9]Haider N, Spicer R, Grier D. Ultrasound diagnosis of infantile hypertrophic pyloric stenosis: determinants of pyloric length and the effect of prematurity. Clin Radiol. 2002;57:136-139.http://www.ncbi.nlm.nih.gov/pubmed/11977948?tool=bestpractice.com[10]Lamki N, Athey PA, Round ME, et al. Hypertrophic pyloric stenosis in the neonate - diagnostic criteria revisited. Can Assoc Radiol J. 1993;44:21-24.http://www.ncbi.nlm.nih.gov/pubmed/8425150?tool=bestpractice.com其他罕见表现包括早期出现胆汁性呕吐,[11]Eyal O, Asis A, Yorgenson U, et al. Atypical infantile hypertrophic pyloric stenosis. Harefuah. 1999;136:113-114,175. [in Hebrew]http://www.ncbi.nlm.nih.gov/pubmed/10914175?tool=bestpractice.com以及与家族性高脂血症和胰腺炎有关联。[12]Veyrac C, Couture A, Bongrand AF, et al. Atypical pyloric stenosis in an infant with familial hyperlipidemia. Pediatr Radiol. 1996;26:402-404.http://www.ncbi.nlm.nih.gov/pubmed/8657477?tool=bestpractice.com