Pyloric Stenosis



Background

  • Hirschsprung described in 1880s
  • Presents in first month
  • M:F =5:1 (esp. first born males)
  • Strong FHx

Signs and Symptoms

  • Vomiting (± projectile)
  • Hungry infant who vomits soon after eating
  • Bilious vomiting very rarely
  • Peristaltic wave from left to right after feeding
  • Eventual dehydration and constipation
  • Jaundice may ensue (1-2%)
  • Mass in RUQ beside rectus muscle

Investigations

  • Dehydration
  • Hypokalemic, hypochloremic metabolic alkalosis
  • Ultrasound (normal pylorus = Pi = 3.14):
    • ↑ length (>3cm) and ↑ thickness (>14mm)
    • “String sign” from narrow pylorus

Management

  • ABC’s
  • NPO/ NG suction
  • Fluid resuscitation
  • Surgery (may delay repair up to 48hrs to rehydrate)
pyeloric stenosis

Content by Dr Íomhar O' Sullivan. Last review Dr ÍOS 12/11/21.