Pyloric stenosis

Pyloric stenosis is an uncommon pediatric condition where there is a congenital narrowing of the pylorus (the opening at the lower end of the stomach). Babies with this condition usually present within the first few weeks (usually 2nd) of life with poor feeding, weight loss and progressively worsening vomiting leading ultimately to projectile vomiting. Males are more commonly affected than females.

Diagnosis

Diagnosis is via a careful history and physical examination. Palpation of the abdomen may reveal a mass in the epigastrium consisting of the enlarged pylorus with palpable peristaltic waves consisting of the stomach trying to force its contents past the narrowed pylorus. Further examination with a barium meal X-ray or gastroscopy may be performed if the pediatric surgeon deems it necessary. Blood tests will reveal hypochlroemic alkalosis secondary to increased vomiting. Ultrasound will show hypertrophied pyloric musculature, sometimes greater than 4 mm.

Treatment

Stabilize the patient by correcting the dehydration and hypochloremic alkalosis with IV fluids. Definitive treatment of pyloric stenosis is with surgical pyloromyotomy - dividing of the muscle layer of the pylorus to release the pressure and open up the distal opening of the stomach to allow feeding to continue.