Use of atropine sulfate in the treatment of infantile hypertrophic pyloric stenosis

Objective: To compare the efficacy of treatment of infantile hypertrophic pyloric stenosis with atropine sulfate and by surgery, with special reference to regression of pyloric hypertrophy. Methods: Thirty-two consecutive infants with pyloric stenosis were seen between January 2008 and June 2011, and 28 cases were enrolled randomly. The diagnosis in all infants was confirmed by an abdominal ultrasound. Medical treatment consisted of intravenous atropine at 0.01 mg/kg every 4 h, followed by oral atropine at 0.02 mg/kg every 4 h. Surgical treatment consisted of standard Ramstedt's pyloromyotomy under general anesthesia. The response to the two treatments was gauged from clinical improvement, weight gain and ultrasonic measurement of pyloric muscle thickness and pyloric canal length. Results: Fourteen infants were treated medically and 14 were given surgical treatment. Medical treatment resulted in complete cure in 8 of 12 infants (66.6%), whereas surgical treatment was successful in all 14 infants (100%; p < 0.05). The mean length of hospital stay was 10 +/- 2 days for medically treated infants and 3 +/- 1 days for those treated surgically (p - 0.0001). Conclusion: Surgical treatment is superior to medical treatment in cases of infantile pyloric stenosis. The success rate of medical treatment with atropine sulfate nevertheless justifies its administration to infants in whom surgery is contraindicated and when medical treatment is preferred by the parents.