Pediatric pyloric stenosis is narrowing of the lower end of the stomach which is due to thickening of the muscles of the pylorus. The narrowing is up to the extent that milk and other stomach contents cannot pass into the small intestine. It is also known as ‘infantile hypertrophic pyloric stenosis’ (IHPS).
Pyloric stenosis typically affects babies 4-6 weeks after birth. The exact cause of this problem is not known.
The most common symptom of pyloric stenosis is forceful and projectile vomiting. Other symptoms include dehydration, weight loss, fewer bowel movements and mild jaundice.
Consistent history and description of the vomiting pattern and appearance, and palpation of a small lump in the mid-abdomen are indicative of pediatric pyloric stenosis. Abdominal ultrasound or barium meal X-ray is used for confirming the diagnosis.
Pediatric pyloric stenosis is a medical emergency and requires immediate treatment. Correction of fluid loss, electrolytes, and acid-base imbalance is the first concern after which a surgical procedure called pyloromyotomy is performed to correct the stenosis.
What are the causes of Pediatric Pyloric Stenosis?
Though the exact cause of pediatric pyloric stenosis is not known, it is believed to be multifactorial, with both, hereditary and environmental factors contributing to the condition. Pediatric pyloric stenosis is known to run in families, often affecting the first male child.
Babies who develop pyloric stenosis are not born with it, but the thickening of the pylorus occurs progressively after birth. It is not known exactly what causes the thickening of the muscles of the pylorus.
What are the symptoms of Pediatric Pyloric Stenosis?
Symptoms of pediatric pyloric stenosis include -
- Vomiting - The baby starts to vomit feeds around 4 weeks after delivery. The vomiting gradually becomes forceful. The vomit mainly contains milk or curdled milk.
- Less urine and stools - Due to the vomiting and absence of milk absorption, the child passes less urine and stools.
- Dehydration - The vomiting also results in the baby getting dehydrated and losing weight.
- Jaundice - The baby may develop jaundice.
How can Pediatric Pyloric Stenosis be diagnosed?
Diagnosis of pediatric pyloric stenosis is done based on:
Physical examination- The pyloric muscle thickening can be felt as a mass. Also, when the baby is examined closely, one can see the stomach pushing hard to empty.
Diagnostic tests –
- Abdominal ultrasound- The thickness and length of the pyloric muscle can be determined by ultrasonography, thus diagnosing the condition.
- Upper GI imaging with barium meal- This test examines the esophagus, stomach, and duodenum. X-rays are taken after swallowing the barium meal. The test demonstrates narrowing at the pylorus and delayed emptying of the stomach contents.
- Upper GI endoscopy- It is used in select cases when other imaging tests are inconclusive or when the infant experiences atypical clinical features.
How can Pediatric Pyloric Stenosis be treated?
Pediatric pyloric stenosis is treated surgically by a procedure called pyloromyotomy.
Management of pediatric pyloric stenosis involves –
- The baby needs to be admitted and any dehydration or electrolyte problems are improved by transfusion of IV fluids.
- After this is achieved, a surgery called pyloromyotomy is required. Under general anesthesia, through a small cut in the tummy, the muscle fibers blocking stomach outlet are divided, allowing the movement of food from the stomach to the intestine.
Sometimes, the baby may still continue to vomit for a day or two after the surgery due to swelling at the operation site.