Pyloric Stenosis

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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.

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.

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 vomitus is clear or the appearance of undigested formula. 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.

The baby is usually quite hungry and eats or nurses eagerly. Green or yellow emesis suggests that your infant may be suffering from another condition that requires prompt evaluation.

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 electrolyte 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. This study may help to identify an alternate cause of vomiting if pyloric stenosis is not present.

 

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 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.

Source: Cincinnati Children’s Hospital Medical Center

 

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