Pyloric stenosis in Babies…

Pyloric stenosis (also called infantile hypertrophic pyloric stenosis or gastric outlet obstruction) is a narrowing of the pylorus – the passage leading from the stomach to the small intestine. When a baby has pyloric stenosis, the muscles in the pylorus have become so thickened and enlarged that food or milk are prevented from emptying out of the stomach into the small intestine. This usually happens in the first six weeks after birth. In this article you will read all the information about Pyloric stenosis.

Some important points:

  • The pylorus is the passage that connects the lower part of the stomach to the small intestine
  • All food leaving the stomach has to go through the pylorus
  • When a baby has pyloric stenosis, the muscles in the pylorus have become too thick to allow food or milk to pass from the stomach into the small intestine
  • Forceful or projectile vomiting soon after feeds is usually the first symptom
  • Pyloric stenosis requires surgical treatment
  • Surgery is performed once your baby’s dehydration is fully corrected by intravenous fluid
  • Pyloric stenosis affects more boys than girls (85:15) and tends to run in families.
  • It is not known what causes the thickening and enlargement of the muscles in the pylorus

Signs and symptoms

  • vomiting
    – persistent vomiting of feeds, usually within 30 minutes of a feed
    – vomiting may be so forceful that the vomit can be projected one meter out of the mouth (projectile vomiting)
    – the vomit is usually yellow, the colour of curdled milk
    – occasionally, the vomit may have small brown specks of old blood in it
    – despite the vomiting babies are usually keen to feed (because they are starving)
  • being miserable:
    – because they remain hungry
    – from stomach cramps which may be painful
  • failure to gain weight or weight loss
  • fewer, smaller stools
  • dehydration:
    – dry mouth and tongue
    – fewer wet nappies or not passing as much urine as usual
    – unusual sleepiness, difficult to rouse (lethargic)
    – sunken eyes
    – the soft spot on the top of the head (fontanelle) is more sunken than normal
  • sometimes you can see ripples or waves across the stomach (abdomen) after a feed – these are muscle contractions (peristalsis) as the stomach tries to empty into the small intestine
Pyloric stenosis requires immediate treatment.
  • You should go to your GP (general practitioner) or after-hours medical centre if your baby has symptoms suggestive of pyloric stenosis. Do not delay as young babies who are not able to feed normally can become more ill very quickly.
The treatment for pyloric stenosis is an operation called a pyloromyotomy.
This is performed by a team that usually includes a pediatric surgeon and a pediatric anesthetist.
A pyloromyotomy can be done using one of three techniques:
  1. open operation – a small cut is made directly over where the pylorus is
  2. umbilical approach – the cut is in the tummy button (umbilicus) itself
  3. ‘key hole’ surgery – three tiny cuts are made
In all the operations, the surgeon then cuts through and spreads the thickened and enlarged muscles of the pylorus, which relieves the blockage (obstruction).

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3 thoughts on “Pyloric stenosis in Babies…

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