Hypertrophic pyloric stenosis in infancy treated with methyl scopolamine nitrate

Abstract

The literature on the medical and surgical treatment of hypertrophic pyloric stenosis of infancy during the last 20 years is reviewed. Results of treatment of 117 unselected cases with methyl scopolamine nitrate are presented. One child required operation after a trial period of medical treatment. There was one death (a mortality rate of 0 8°o). Methyl scopolamine nitrate can be administered by mouth or by subcutaneous injection and no toxic effects were observed in the dosage used. Response to treatment was usually rapid. Sixty- four per cent of infants ceased vomiting immediately, and 80% in the first 48 hours. The factors of birth weight, length of history, or presence of dehydration did not seem to bear any relationship to rapidity of response to treatment. Therefore no particular criteria are suggested as contraindications. A strict regime of feeding with a reduced fluid intake at the start is essential. The period in hospital can probably be reduced to less than four weeks and less than 14 days in most cases. The importance of proper accommodation for nursing these patients in isolation and the necessity for an experienced nursing staff are stressed.