Olive Palpation, Sonography and Barium Study in the Diagnosis of Hypertrophic Pyloric Stenosis: Decline in Physicians’ Art

Background/objective: hypertrophic pyloric stenosis (hps) is the commonest indication ofpediatric surgery in neonatal period and early infancy. there are some clinical and radiologicalmethods for the diagnosis of hps. as an example, a positive “olive sign” in the abdominalexamination is diagnostic; however, it seems that performing physical examination for thedetection of this sign has been abandoned and that this practice has been replaced by sonographyand other paraclinical tests. the aim of this study was to assess the ability of ourphysicians in finding the palpable olive in clinical examination and the accuracy of sonographyand the true positive rate of barium study.patients and methods: we evaluated 84 patients admitted to our hospital during a 7-yearperiod in which the final surgical report was hps. clinical examination for the right upperquadrant (ruq) olive like mass, barium study and ultrasound findings of hps were evaluated.pediatric residents (junior and senior residents) examined all these cases. twenty-one patientshad a barium study and 81 had a sonography, which was performed by an attendingradiologist. data were evaluated for the diagnostic yield (dy) of all these diagnostic tools.results: the mean age of the patients was 36.1 days on admission and the male/female ratiowas 5.4/1. all the patients had a clinical examination, in which the olive sign was detected inonly 13 cases (dy= 15.5%, 95% ci: 12%–19%); 81 patients had a sonography, in 71 of whom hpswas detected (dy = 87.7%, 95% ci: 85%–92%); barium study revealed hps in 16 of 21 patients(dy = 76.2%, 95% ci: 71.4%–82%).conclusion: sonography was more precise than clinical examination and barium study in detectinghps. due to the crying baby and the distended stomach, less time is spent for clinicalexamination. therefore, paraclinical studies such as imaging become the first step in diagnosisand are requested earlier and even as the first diagnostic study on admission. this leadsto reduction of doctors’ experience in finding the olive sign.