Sir.—We noted with dismay that Tack et al1 failed to appreciate that pyloric stenosis in a sick premature infant is readily diagnosed by palpating a pyloric tumor. If the diagnosis is suspected, recourse to radiologic investigation is unnecessary. The key to the diagnosis of pyloric stenosis in the sick premature infant is the knowledge that it can occur and can be diagnosed accurately clinically. Indeed, in our experience, palpation of the pyloric tumor is somewhat easier in the sick premature infant than in the otherwise well older infant. Furthermore, careful observation of the upper abdomen reveals conspicuous gastric peristalsis.
It seems a sad trend that the diagnosis of such a simple pediatric condition is not being made clinically. We hope that the art of clinical examination is not being lost in high-tech units, where it seems to be easier to resort to radiologic investigation.
BEASLEY SW, HUTSON JM. Pyloric Stenosis in Sick Premature Infants. Am J Dis Child. 1989;143(2):142. doi:10.1001/archpedi.1989.02150140024010