What is pyloric stenosis? |

Causes and Symptoms

The exact cause of pyloric stenosis is unknown. The condition is usually characterized by nonbilious projectile vomiting beginning at three weeks of age, although it may occur as early as the first week of life or as late as five months of age. The vomiting is progressive and leads to poor growth and dehydration. Initially, the vomit resembles the fluid that the infant ingested, but it may become brownish in later stages of the disease.

Treatment and Therapy

Pyloric stenosis is diagnosed through palpation of a small, firm mass, similar to the size and shape of an olive, in the mid-upper abdomen. This mass is not palpable in all infants with pyloric stenosis. In these cases, imaging procedures such as an upper gastrointestinal (GI) series or ultrasound of the upper abdomen can confirm the diagnosis.

The initial treatment of pyloric stenosis involves correction of dehydration with intravenous fluids. The surgical treatment is called a pyloromyotomy. After the infant is anesthetized, an incision is made in the right-upper abdomen, through which the pyloric mass is removed. The pyloric muscle is split down to the mucosa, or lining of the stomach. Postoperative vomiting is common and is probably caused by slow emptying of fluids from the stomach. The vomiting usually resolves, however, such that the infant may resume feeding within twenty-four hours after surgery, with advancement to regular feeding within two days. This operation is usually curative, with low mortality and recurrence rates.

Perspective and Prospects

Pyloric stenosis was first described in 1788. Harald Hirschsprung coined the term “congenital hypertrophic pyloric stenosis” in 1888. At that time, approximately one-fourth of infants affected by pyloric stenosis died without treatment, while more than half of the infants with this condition died after surgery. A significant advance in the treatment of pyloric stenosis came in 1912 when Conrad Ramstedt reported performing a pyloromyotomy. The procedure that he described remains the standard treatment.

Bibliography

Kliegman, Robert and Waldo E. Nelson, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders/Elsevier, 2011.

Christian, Janet L., and Janet L. Greger. Nutrition for Living. 4th ed. Redwood City, Calif.: Benjamin/Cummings, 1994.

Cockburn, Forrester, et al. Children’s Medicine and Surgery. New York: Oxford University Press, 1996.

Garrow, J. S., W. P. T. James, and A. Ralph, eds. Human Nutrition and Dietetics. 10th ed. repr. New York: Churchill Livingstone, 2004.

Kaneshiro, Neil K. "Pyloric Stenosis." MedlinePlus, August 2, 2011.

Keet, Albertus D. The Pyloric Sphincteric Cylinder in Health and Disease. New York: Springer, 2012.

Martin, Richard J., Avroy A. Fanaroff, and Michele C. Walsh, eds. Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant. 9th ed. St. Louis, Mo.: Mosby/Elsevier, 2011.

Smith, Nathalie. "Pyloric Stenosis." Health Library, September 26, 2012.