Physical Examination for 'Initial Evaluation' of Hypertrophic Pyloric Stenosis FREE

Sir.—I agree with Foley et al¹ that ultrasound should not be used for the "initial evaluation" of vomiting in infants. I would go one step further to deplore the use of any roentgenographic or imaging study for the "initial evaluation" of vomiting in infants. The initial evaluation should have been a good history and physical examination that might have eliminated the need for ultrasound or an upper gastrointestinal tract series in most, if not all, of the 37 patients proved by their studies to have hypertrophic pyloric stenosis. Unfortunately, it appears that the knack of palpating a pyloric "olive," which requires evacuation of the stomach and relaxation of the infant's abdominal wall, is not being transmitted from experienced attending physicians to house staff and thus is becoming a lost art. In the absence of a palpable olive, the upper gastrointestinal tract series is the study most likely to