Gastric foveolar cell hyperplasia and its role in postoperative vomiting in patients with infantile hypertrophic pyloric stenosis.

BACKGROUND: Foveolar cell hyperplasia (FCH) has been reported as a rare cause of persistent gastric outlet obstruction in patients with infantile hypertrophic pyloric stenosis (IHPS), which, if present, requires excision of the gastric foveolar folds to resolve the persistent obstruction. This is a review of patients with IHPS diagnosed on abdominal ultrasound to determine the incidence of FCH in IHPS and to evaluate whether it has a causal role in postoperative vomiting following pyloromyotomy for IHPS.

METHODS: The ultrasound images of all children presenting with suspected IHPS to our institution from January 2001 to May 2006 were independently reviewed by our radiology department for evidence of FCH. Three hundred and twenty-nine ultrasounds were performed during this period for suspected IHPS, and 93 cases of IHPS were diagnosed. Eleven of 93 patients with IHPS had FCH, amounting to an incidence of 12 %. FCH was not seen in any of the remaining 236 patients who did not have IHPS.

RESULTS: FCH appears to be a common condition in patients with IHPS (12 %) and may be responsible for postoperative vomiting. In patients in whom FCH was diagnosed preoperatively, an extended pyloromyotomy was performed in all except one patient. One patient with FCH and IHPS had persistent postoperative vomiting following extended laparoscopic pyloromyotomy but vomiting resolved after conservative measures. The only patient who underwent a non-extended pyloromyotomy by the open method was readmitted with significant persistent vomiting and underwent a second laparotomy with excision of redundant mucosa and an extended pyloromyotomy, resulting in resolution of vomiting.

CONCLUSION: An extended pyloromyotomy appears to be adequate surgical treatment for patients with IHPS and FCH.