Pyloric Stenosis

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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