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Background: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in infants. This study was conducted to identify the accuracy of ultrasonography in the diagnosis of infantile Hypertrophic pyloric Stenosis. Methods: This cross-sectional descriptive. Study was conducted in Department of radiology and imaging, institute of child and mother health during two year period from 16 September 2016 to 16 September 2018. Fifty patients <8 weeks of age who presented with complaints of non-bilious vomiting were included in the study. Abdominal ultrasound was performed in all the cases. On ultrasonography pyloric canal length, diameter and pyloric muscle wall thickness was measured. Open surgery was performed as per indications and after informed consent. The pre-operative findings were compared with ultrasongraphic findings. Study variable were male to female ratio, percentage of cases in which pyloric mass was palpable. We also compare the duration of onset of symptoms with pyloric canal length, diameter and muscle thickness. Results: In this study, out of 50 patients, 46 (92%) were male and 4 (8%) were females. Gastric peristalsis was visible in 100% patients and mass was palpable in 14 (28%) patients. Pyloric canal length was more than standard in 98% cases; canal diameter was more than the standard in 87% cases and pyloric muscle thickness in 60% of cases. Ultrasonographic findings remained 98% accurate in this study. Conclusion: Ultrasonography is an investigation of choice for early diagnosis of IHPS before significant fluid and electrolyte imbalance occur. It is cost effective, harmless, freely available and easier to perform. J Dhaka Med Coll. 2019; 28(2) : 208-211 1. Dr. Gopal Chandra Saha, Assistant Professor, Institute of child and Mother Health, Matuail, Dhaka 2. Dr. Prodip Kumar Biswas, Associate Professor, Department of Medicine DMC, 3. Dr. Md. Nasir Uddin, Associate Professor, Department of Clinical Biochemistry, National Institute of Cardiovascular Disease & Hospital, Dhaka Department of Biochemistry, NICVD, Dhaka, 4. Dr. Sahadat Hossain, Assistant Professor, OSD, DGHS 5. Dr. Nur-Wa-Bushra Jahan, Assistant Professor, department of Obstetrics & Gynaecology, Sir Salimullah Medical College & Mitford hospital, Dhaka 6. Dr. Mst. Habiba Khatun, Associate Professor, Department of Radiology and Imaging, BSMMU, Dhaka 7. Dr. Md. Zobaer Ahmed, Indoor Medical Officer, Department of Medicine, DMCH 8. Dr. A H Chowdhury, Associate Professor of Clinical Neurology, DMCH Correspondence : Dr. Gopal Chandra Saha, Assistant Professor, Institute of child and Mother Health, Matuail, Dhaka Emaildrgopalcs@gmail.com Cell no-01711315850 Received: 12-11-2019 Revision: 17-11-2019 Accepted: 20-12-2019 Introduction Hypertrophic pyloric stenosis (HPS) is actually idiopathic hypertrophy and hyperplasia of the circular muscle fibers of the pylorus with proximal extension into the gastric antrum. Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric out let obstruction in infants. Prevalence of infantile hypertrophic pyloric stenosis ranges from 1.5 to 4.0 per 1000 live births among whites but is less common in Africans, Americans and Asians. IHPS was first described two hundred years ago but still exact cause is poorly understood.1 Pyloromyotomy first described by Remsteadt in 1912 is still accepted as curative operation of choice without any modification.2 Non bilious vomiting is the initial symptom of the disease. During clinical examination, Palpable olive in the right hypochondrium or epigastrium is diagnostic. Jildi S mention in his study that pyloric tumor was palpable in 19.7% patient’s only.3 Barium study helps in diagnosis of IHPS by showing delayed gastric emptying string sign or double track sign.4 Ultrasonography is useful, noninvasive and accurate technique to diagnose infantile hypertrophic pyloric stenosis. Ultrasonography is freely available everywhere. Most commonly used criteria for positive ultrasound study is pyloric muscle wall thickness 4mm or more and pyloric canal length 16 mm or more. Lamaki Mentioned in his study muscle wall thickness 3mm or more as positive finding for IHPS in infants less than 30 days of age 5. Different criteria have been mentioned in different studies. In our study. We tried to establish diagnostic criteria in our setting by comparing ultrasonographic and operative findings. Material and methods This was a cross sectional descriptive study, conducted at department of radiology and imaging, institute of Child and Mother Health, Matuail, Dhaka during two years period from 16th September 2016 to 16th September 2018. Fifty patients <8weeks of age were included in the study who come to radiology department during this time period with complains of nonbilious vomiting. Abdominal ultrasonography was done in all patients 5 MHZ linear probe in Xario 100 Toshiba machine. On ultrasonography canal length, diameter and pyloric wall thickness were measured. Following criteria was selected for the diagnosis of IHPS on ultrasonography. · Pyloric canal length 16mm or more · Pyloric canal diameter 14mm or more · Pyloric muscle wall thickness: 3 mm or more. The patient diagnosed as IHPS on ultrasonography were considered for surgery. The surgical finding of each patient were compared with the ultrasonographic findings and assessment was made regarding conformity of surgical with ultrasonography findings. Result A total of 50 patient were admitted during the study period with complains of non bilious vomiting. Out of fifty, 46 (92%) were male and 4 (8%) were female. All the patients were above 2 weeks of age. One was between 3-4 weeks, 15 (30%) were between 3-4 weeks, 14 (28%) between 4-5 weeks, 10 (20%) between 5-6 weeks and 10 (20%) above the age o6 weeks. Table-1 shows duration of vomiting at presentation and table -2 shows comparison of duration of vomiting and pyloric canal length. Diameter and muscle wall thickness. Pyloric canal length was more than the standard in 98%, canal diameter in 87% and pyloric muscle thickness in 60% cases. Ultrasound findings were confirmed preoperatively and found to be 98% accurate in this study.

Ultrasonographic Evaluation in Early Diagnosis of Infantile Hypertrophic Pyloric Stenosis