Pyloric stenosis

Hypertrophy and spasm of pyloric muscle causes gastric outlet obstruction, typically between 4 to 8 weeks of age.

Pyloric stenosis is comparatively more common in a first born child and in boys.

 

History

– Infants present with persistent vomiting which is projectile and effortless.

– Vomitus is never bile stained, though streaks of blood can be present.

– Vomiting becomes more frequent and forceful over time.

– Babies are initially hungry, but can become lethargic and dehydrated over time resulting in weight loss, dry nappies and constipation.

 

Examination

– Babies can be clinically dehydrated

-During a test feed, one might palpate ‘olive sized’ hypertrophied pylorus in epigastric area, or peristaltic waves can be visible in the left upper quadrant.

 

Investigations

Persistent vomiting can lead to loss of acid and gastric fluid containing potassium and chloride.

– U&E can show dehydration, low K⁺, low Cl^–and low HCO₃.

– Blood gas reveals metabolic alkalosis

– Ultrasound examination confirms thickened and elongated pylorus.

 

Management

Consider differentials of gastro-oesophageal reflux, acute gastroenteritis, cow’s milk protein intolerance or overfeeding.

– Fluid and electrolyte resuscitation to correct dehydration and hypochloraemic alkalosis.

– Surgical intervention with Ramstedt’s pyloromyotomy includes longitudinal incision in the anterior wall of pylorus to release the construction.