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Pyloric Stenosis is a condition that is often seen in children, almost always in infants. It can also be called Infantile Hypertrophic Pyloric Stenosis

It is typically seen in the first few months of life. It occurs when there is a severe projectile vomiting that is “non-bilious“.  The cause is largely due to stenosis. Stenosis indicates a narrowing and in this case it is a narrowing of the Stomach.

Pyloris is referred to or also known as “the gate”. It is found in the first part of stomach – the lower stomach – near where the stomach attaches to the Small Intestines. This part of the small intestine is known as the duodenum.

Pyloric Stenosis is seen more often in male babies. Firstborn males are four times more likely. It develops in the first 2-6 weeks after birth. It is ore common in Caucasians than Hispanics, Blacks, or Asians.

***Pyloric stenosis in adults can be seen from scarring from peptic ulceration.

Adult form is somewhat different than infantile form.

Causes

–  Enlargement of the muscle surrounding the opening.
–  The muscle spasms as the stomach empties.
–  ***Infant exposed to Erythromycin (an antibiotic) have a slightly increased risk of developing this stenosis – especially when the drug is taken around the second week of life.

Symptoms

–  Present with worsening vomiting.
–  Vomiting can be progressive.
–  Vomiting is projectile.
–  More forceful than normal spitting-up
–  Weight-loss
–  Poor feeding
–  Dehydration
–  Cry without tears if dehydrated
–  Fewer bowel movements
–  Fewer wet diapers.
–  Belching
–  Colic
–  Constant hunger
–  Crying due to hunger

Diagnosis

–  An olive-shaped mass can be felt in the middle to upper right of the infant’s abdomen.
–  Careful history must be given.
–  Ultrasound can be done to show thickening of the pylorus.
–  Blood tests can show electrolyte changes including: Potassium, Calcium, and other changes.

Treatment

–  Management of this condition is often done through surgery.
–  Occasionally – mild cases can be treated through medication.
–  Surgery is required to help with dehydration and malnourishment.
–  Without surgery – outcome can be fatal.

Surgery

–  Pyloromyotomy is done
–  This is done through the Ramstedt’s procedure.
–  The muscle is opened and divided.
–  Can be done through x 1 opening (3-4 cm) or through Laparoscopic
–  When the muscle is divided – it opens the pylorus and the gastric outlet allowing a greater concentration of food to enter and be absorbed.