A case of hypertrophic pyloric stenosis diagnosed immediately at the bedside by an emergency physicians (EP) using point-of-care ultrasound is presented.

hypertrophic pyloric stenosis (HPS) is an important diagnosis for the EP to consider in at-risk patients. The sonographic findings are easily obtained and interpreted by EPs, even with limited training.

Earlier diagnosis or exclusion of this disease process should lead to more focused patient evaluations, consultation and management while decreasing the use of other resources.

A 15-day-old male who was born at term presented with non-bilious projectile vomiting. He was nontoxic and his abdomen was benign without masses.

Point-of-care ultrasound (POCUS) showed hypertrophic pyloric stenosis (HPS).

Typical findings include target sign; pyloric muscle thickness greater than three millimeters (mm); channel length greater than 15–18 mm; and lack of gastric emptying.

The patient was admitted; consultative ultrasound (US) was negative, but repeated 48 hours later for persistent vomiting.

This second US was interpreted as HPS, which was confirmed surgically. Pyloromyotomy was successful.

Read More