Definition
- Disorder of young infants
- Caused by hypertrophy of the pylorus,
- Can progress to near-complete obstruction of the gastric outlet
- Leading to forceful vomiting.
Incidence
- 1.5-4 per 1000 live births in Caucasians
- Lower incidence in African and Asian children
- 85% occurs in males
- 20% of those affected have a family history of pyloric stenosis
- Usually occurs between 10 days and 11 weeks old
- Rare to be before or after that
Pathophysiology
- Not a congenital abnormality
- Develops after birth
- Hypertrophy of the pylorus
- In the circular muscular layer and mucosa
- No cause yet found
Presentation
- Non-bilious vomiting at 2-8 weeks of age,
- Initially vomiting may not be frequent or forceful
- Eventually progresses to projectile vomiting
- Examination findings:
- May be dehydrated
- Hungry
- Visible peristalsis in the upper abdomen (gastric contraction)
- Palpation of pylorus in the epigastrium (the “olive”)
Diagnosis
- Bloods
- Often has hypochloraemia, hyponatremia and hypokalaemia
- Metabloic alkalosis
- Ultrasound scan
- Barium swallow if USS not available
Management
- Rehydration - correction of hypochloraemia and other electrolyte abnormalities prior to surgery
- Surgery - Ramstedt operation
- Pyloromyotomy
- May be done open or laparoscopic
- Pyloric muscle is split longitudinally down to the mucosa
- Normal oral feeds can be commenced 24 hours post op