Pyloric Stenosis

Last updated 03.11.12

Definition

-  Gastric outlet obstruction caused by stenosis of the pyloric valve

 

Features

-  3/1,000 live Caucasian births

-  Boys 4:1 girls, increased in first born

-  Type B & O blood groups

 

Diagram

 

Associated S/S

-  Non-bilious vomiting

-  Progressive

-  Post prandial

-  Usually begins by 3 weeks (1/7 to 5/12)

-  Hungery post vomit

-  Abdominal pain & nausea

-  Abdominal distension

-  Firm, moveable, olive shaped abdominal mass

-  2cm +/-

-  Superior & right to umbilicus inferior to liver edge

-  Easier to palpate post vomit

-  Post prandial visible peristalsis

-  May be associated w other birth defects

-  Esp tracheoesophageal fistula

 

Dx

-  Clinical in 80%

-  DDx: GORD (AXR, U&E)

 

Ix

-  U&E: hypochloraemic metabolic alkalosis

-  Abdominal US

-  Pyloric thickness > 4mm

-  Pyloric Length > 14mm

-  95% sensitive

-  Barium swallow

-  Shoulder Sign: pyloric m. buldge

-  Double Tract Sign: parallel streaks of barium in narrow channel

 

Long

 

Thick

 

Mx

-  IV fluids + KCl: correction of alkalosis

-  Sx

-  Ramstedt pyloromyotomy

-  Feed 12-24 hrs post op

 

 

 

References