Background
- Hypertrophy of the pyloric sphincter causes narrowing of the gastric outlet
- Most common cause of gastric obstruction in patients 2-12 weeks old
- Risk factors include male (4:1); firstborn (2:1); white/caucasian; term infants; bottle-fed babies
Presentation
- Usually present around 3-6 weeks with a history of progressively worsening non-billious vomiting (may be projectile) after feeds
- may be blood stained
- Associated with
- poor weight gain, decreased urine output (fewer wet nappies) and stools, excessive hunger, dry mucous membranes and depressed fontanelle
- rarely, once severe, tachycardia and jaundice may occur
- Assess degree of dehydration; weight
- Observe a normal feed
- Examination of the abdomen may reveal an epigastric ‘olive-shaped’ mass
Investigations
- Blood tests to consider include FBC, U&Es, venous acid-base, glucose, bilirubin
- Hypokalaemia and hypochloraemia (possibly hyponatraemia)
- Metabolic alkalosis
- USS can usually identify hypertrophied pylorus
- Contrast studies may be used if USS unequivocal
Management
- Fluid resuscitation- correct any electrolyte disturbance (particularly hypokalaemia) prior to surgery
- Nil by mouth and nasogastric drainage or suction prior to surgery and between feeds
- Surgery
- Pyloromyotomy
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