Pyloric Stenosis
Also known as . . .
hypertrophic pyloric stenosis
What is it?
Pyloric stenosis is a condition caused by
a thickening (hypertrophy) of the pylorus, the muscle at the outlet of the stomach. The
cause of pyloric stenosis is not known. Any infant may get pyloric stenosis during the
first three months of life, although it occurs most commonly in first born male infants in
the fifth or sixth week of life. Babies come to medical attention because of increasingly
forceful vomiting of feedings. Sometimes the symptoms of pyloric stenosis come on
gradually and the babies may have had several formula changes prior to coming to a
diagnosis. In extreme cases, babies with pyloric stenosis become very dehydrated, with
severe changes in their blood electrolyte levels.
Diagnosis and Treatment of
Pyloric Stenosis
The diagnosis of pyloric stenosis is made
through a combination of history, physical examination, x-rays and/or ultrasound. The
history of a several week old infant with worsening episodes of vomiting after feedings
suggests pyloric stenosis. The vomiting may be referred to as "projectile"
because of its forcefulness. During physical examination the enlarged pyloric muscle can
sometimes be felt. The enlarged, firm pyloric muscle felt in the upper abdomen of infants
with pyloric stenosis is referred to as the "olive". An upper GI (barium
swallow) test or an ultrasound of the upper abdomen is usually used to confirm the
diagnosis or to look for other causes of vomiting. Either of these tests is very effective
for diagnosing pyloric stenosis, when performed by an experienced radiologist.
When the diagnosis of
pyloric stenosis is made, your physician will make arrangements for your baby to be
admitted to the hospital. Your baby will be given intravenous fluids to correct any
dehydration and electrolyte abnormalities that may have developed. When dehydration has
been corrected, a procedure called a pyloromyotomy will be performed. We most often
perform the procedure using minimally invasive surgical techniques (laparoscopy). A small
camera (laparoscope) is placed into the abdomen through the belly button and two tiny (3
millimeters) incisions are made. In this procedure, the enlarged pyloric muscle is split
apart allowing it to relax so that food may again empty from the stomach. The incisions
are closed with dissolving stitches and tapes. Feedings resume shortly after surgery.
Families are usually ready to go home the day after surgery. Physicians in the Division of
Pediatric Surgery at Penn State Milton S. Hershey Medical Center treat infants with
pyloric stenosis. Our team of radiologists, surgeons, anesthesiologists, nurses, and child
life specialists is dedicated to providing both you and your child with the best operative
experience possible.
Glossary of Terms
Stomach: the portion of the
gastrointestinal tract responsible for receiving and temporarily storing swallowed food
Pylorus: the muscular outlet of the
stomach
Laparoscopy: the technique of operating on
the abdomen via a small camera inserted through the belly button assisted by instruments
inserted through small poke holes rather than a single large incision.
Ultrasound: the use of sound waves to
obtain pictures of internal structures
Barium swallow (upper GI): a test in which
contrast material is administered by mouth to enable the taking of specialized x-rays,
which aid in diagnosis
Physicians who treat Pyloric Stenosis
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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