pyloric stenosis

Pyloric Stenosis

Related Services

• Gastroenterology, Hepatology and Nutrition
  
• Surgery
  

What is pyloric stenosis?


Pyloric stenosis is the narrowing of the lower portion of the
stomach (pylorus) that leads into the small intestine. The muscles in
this part of the stomach enlarge, narrowing the opening of the pylorus
and preventing food from moving from the stomach to the intestine. This
problem typically occurs in infants between 2 and 8 weeks of age and
affects 1 out of every 500 to 1,000 live births.
Why is pyloric stenosis a concern?


Since the stomach opening becomes blocked, food cannot move into the
intestine. This causes a baby with pyloric stenosis to vomit forcefully
after eating. As a result of this vomiting, several problems can arise.

The most serious problem is dehydration (excessive water loss from
the body). A baby who vomits regularly will not get sufficient fluids
to meet his / her nutritional needs.
Additionally, minerals that the body needs to stay healthy, such as
potassium and sodium, are lost through vomiting. Lacking an adequate
amount of both water and minerals can cause infants to lose weight and
to become extremely sick very quickly.
What causes pyloric stenosis?


No particular cause of pyloric stenosis has been clearly identified,
though both genetic and environmental factors are thought to be
involved. It is known, however, that there is nothing that can be done
to prevent its occurrence.
Who is at risk for developing pyloric stenosis?


Pyloric stenosis is considered a multifactorial trait, which means
that many factors are involved. In many defects with multifactorial
traits, one gender is affected more frequently than the other. For
example, pyloric stenosis is four times more common in males than in
females.
In families where one child has pyloric stenosis, there is an
increased risk that a future brother or sister could also have this
condition. Adults who have had pyloric stenosis when they were infants
may pass the trait on to their children.
If a child with pyloric stenosis is female:

• The likelihood of having a future son with pyloric stenosis is 1 in 5
  
• The likelihood of having a future daughter with pyloric stenosis is 1 in 14
  

If a child with pyloric stenosis is male:

• The likelihood of having a future son with pyloric stenosis is 1 in 20
  
• The likelihood of having a future daughter with pyloric stenosis is 1 in 40
  

Other Pyloric Stenosis Risk Factors

• Caucasians seem to develop pyloric stenosis more frequently than babies of other races
  
• Due to the hereditary factor, several members of a family may have had this problem in infancy
  

What are the symptoms of pyloric stenosis?


The most common symptom of pyloric stenosis is forceful, projectile
vomiting, which is quite different from a "wet burp" that a baby may
have at the end of a feeding. The baby is usually quite hungry and eats
or nurses eagerly.
Large amounts of breast milk or formula are then vomited and may go
several feet across a room. The milk is sometimes curdled in appearance
due to the fact that it remains in the stomach where it is exposed to
acid.
Other symptoms include:

• Weight loss
  
• Dehydration
  
• Lethargy (lack of energy)
  
• Fewer bowel movements
  
• Constipation
  
• Mild jaundice (yellowish coloring in skin)
  

How is pyloric stenosis diagnosed?


Careful physical examination generally reveals a firm mass, the size
of an olive, in the mid-abdomen. Your physician may advise other
diagnostic procedures to confirm the diagnosis and to eliminate
conditions with symptoms similar to those seen in babies with pyloric
stenosis. These procedures include:

• Blood tests – These are done to evaluate dehydration and mineral imbalances.
  
• Abdominal ultrasound - This is an imaging
  technique that uses high frequency sound waves and a computer to create
  images of blood vessels, tissues, and organs. It is used to determine
  the thickness and length of the pyloric muscle.
  
• Barium swallow / upper GI series – This test
  examines the organs comprising the upper part of the digestive system,
  which are the esophagus, stomach, and duodenum (the first section of
  the small intestine). A dense, chalky fluid called barium, which is
  used to coat the inside of organs so they will show up on an X-ray, is
  swallowed. X-rays are then taken to evaluate the digestive organs. This
  test will also demonstrate a delayed emptying of the stomach content as
  well as the narrowing of the pylorus.
  

How is pyloric stenosis treated?


Pyloric stenosis is treated in two stages. First, fluids are given
intravenously to treat dehydration and restore the body's normal
chemistry.
Once this is done, an operation called a pyloromyotomy is performed.
This opens up the tight muscle that has caused the narrowing in the
stomach, allowing the passage of food from the stomach to the
intestine.
This surgery can be performed using either an open or laparoscopic surgical approach.
What to expect after surgery


Pain


While in the operating room, your baby will receive a pain
medication that is injected into the incision. This should allow
him/her to feel and appear comfortable for about 6 to 8 hours after
surgery. If necessary, acetaminophen (medication such as Tylenol") may
also be given to help ease discomfort.
Feedings


Within two hours after surgery, small amounts of milk or liquids are
given. Over a 24- to 48-hour period, feedings are gradually increased.
As soon as your baby can tolerate normal feedings (usually one to two
days after surgery), he/she will be discharged from the hospital.
Vomiting


Although a baby often vomits for 24 to 48 hours after surgery, this
usually disappears without any further treatment. Occasionally,
however, vomiting may persist for 4 to 5 days.
Incision


Your baby's incision should be kept clean and dry, and no tub baths
should be given for two days after surgery. Steri-strips (bandage-like
tape) that are placed over the incision should be left in place and
then removed according to the instructions of your pediatric surgeon.
They are generally left in place for 7 to 10 days.
Call your Child's Pediatric Surgeon If:

• Your baby's temperature is above 101.5° F (38.6° C), even if it drops below this when acetaminophen is given
  
• There is an increase in redness or swelling at the incision site or if this site has drainage with a foul odor
  
• Pain is not relieved by medication
  
• There are signs of dehydration such as fewer wet diapers each day,
  the absence of tears when crying, or a fontanel (soft spot on the head)
  that appears sunken
  
• Vomiting occurs with more than three consecutive feedings or lasts longer than 48 hours after discharge
  

What is the long-term prognosis for babies with pyloric stenosis?


There are no long-term effects of surgery, and there is less than a 1% chance that pyloric stenosis will recur.

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