Pyloric stenosis is an uncommon condition that affects infants from birth to 6 months of age and causes projectile vomiting, which can lead to dehydration. The muscle between the stomach and the intestines, called the pylorus, swells, which causes excessive spit-up and vomiting, leading to weight loss. Dr. Bornstein discusses the symptoms, diagnosis, and treatment for pyloric stenosis, also known as infantile hypertrophic pyloric stenosis.
DEFINITION:
Infantile hypertrophic pyloric stenosis is a muscle hypertrophy at the outlet of the stomach.
SYMPTOMS:
- Excessive spitting up
Followed by
- Projectile vomiting
- Weight loss
If left untreated, dehydration will ensue. This can lead to long-term complications, including shock and death.
CAUSES:
Unknown. It usually occurs in first-born males and tends to run in families. It may have something to do with hormone levels stimulating muscle hypertrophy at the pyloric outlet.
DIAGNOSIS:
The diagnosis is considered with a history of projectile vomiting and weight loss. On abdominal examination, a mass the size of an olive pit may be felt, although this can be difficult. If the olive pit mass is felt, the diagnosis is confirmed. If not, an upper GI barium swallow or ultrasound of the abdomen can determine the diagnosis. In an upper GI barium swallow, the infant will swallow a chalky-white substance called barium. A video x-ray can then show the barium entering and leaving the stomach. In pyloric stenosis, the barium cannot leave the stomach. An ultrasound can show the enlarged muscle obstructing the outflow of the stomach.
CONTAGION:
Pyloric stenosis is not a contagious illness.
TREATMENT:
The treatment is to relieve the obstruction surgically.
OUTCOME:
Excellent with treatment. Without treatment, the outcome is poor, and the child will be unable to get any nourishment and can eventually succumb to dehydration and shock.
DISCUSSION:
Pyloric stenosis happens in 1 out of 150 male infants and 1 out of 750 female infants. The cause is unknown. A child will be feeding normally and gaining weight. Then at around one to two weeks of age, reflux will ensue. Over the next one to two weeks, the reflux will become projectile vomiting, and the infant will start to lose weight. The diagnosis is usually made at ages three to five weeks. Once a diagnosis is established, dehydration and electrolyte disturbances are corrected by giving intravenous fluids. Then surgery is performed. The procedure is called a Fredet-Ramstedt Pyloromyotomy. The muscle causing the obstruction is cut open. After surgery, re-feeding can begin within a few hours, and full feedings can be re-established within 24 hours. If this goes well, then the problem is solved. If not, an incomplete surgical pyloromyotomy or other causes must be investigated.
ONE DOCTOR’S OPINION:
Reflux? Or pyloric stenosis? That is always what goes through my mind when a child is spitting up or vomiting in the first month of life. If there is weight gain, it’s reflux. With weight loss, I think pyloric stenosis. An upper GI will tell me if I’m not sure. If I’m sure it’s reflux, I’ll treat that. If I’m sure it’s pyloric stenosis, I’ll get a surgical consult and forego any study since some surgeons prefer to feel the olive pit mass. Others like to do an upper GI and want just an ultrasound. It’s all a matter of personal preference. If it is pyloric stenosis, surgery fixes the problem with no long-term sequelae.
This blog was written by Dr. Michael Bornstein, who has 30 years of experience as a pediatrician.
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.
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