Pyloric stenosis

Last reviewed: 26 Apr 2022
Last updated: 15 Jan 2020

Summary

Definition

History and exam

Key diagnostic factors

  • first-born male infant
  • non-bilious projectile vomiting
  • 3 to 6 weeks old
  • upper abdominal mass
  • peristaltic waves
More key diagnostic factors

Other diagnostic factors

  • family history of pyloric stenosis
  • multiple formula changes
  • tachycardia
  • decreased wet nappies
  • dry mucous membranes
  • flat or depressed fontanelles
  • constipation
  • poor weight gain
  • irritability
Other diagnostic factors

Risk factors

  • prematurity
  • early exposure to erythromycin
  • maternal exposure to macrolides
  • first-born male infant
  • family history of pyloric stenosis
More risk factors

Diagnostic investigations

1st investigations to order

  • chemistry panel
  • ultrasound abdomen
More 1st investigations to order

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Catherine J. Hunter, MD

Assistant Professor of Pediatric Surgery

Ann and Robert H. Lurie Children’s Hospital of Chicago

Chicago

IL

Disclosures

CJH declares that she has no competing interests.

Samuel C. Klonoski, MD

Pediatric Surgery Research Fellow

Ann and Robert H. Lurie Children’s Hospital of Chicago

Chicago

IL

Disclosures

SCK declares that he has no competing interests.

Acknowledgements

Dr Catherine Hunter would like to gratefully acknowledge Dr Jeffrey S. Upperman, Dr Yigit S. Guner, and Dr Arturo Aranda, previous contributors to this topic. JSU, YSG, and AA declare that they have no competing interests.

Peer reviewers

Evan Nadler, MD

Assistant Professor of Surgery

Department of Surgery

Division of Pediatric Surgery

NYU Medical Center

New York

NY

Disclosures

EN declares that he has no competing interests.

Lewis Spitz, PhD FRCS MD (Hon), FRCPCH FAAP (Hon), FCS (SA) (Hon)

Emeritus Nuffield Professor of Paediatric Surgery

Institute of Child Health

University College

London

UK

Disclosures

LS declares that he has no competing interests.

Ruth Hallows, BSc, MB BS, FRCS, FRCS III (Pediatric Surgery)

Consultant in Paediatric and Neonatal Surgery

Royal Alexandra Children's Hospital

Brighton

UK

Disclosures

RH declares that she has no competing interests.

  • Pyloric stenosis images
  • Differentials

    • Gastro-oesophageal reflux
    • Over-feeding
    • Malrotation
    More Differentials
  • Guidelines

    • ACR appropriateness criteria: palpable abdominal masss-suspected neoplasm
    • ACR appropriateness criteria: vomiting in infants up to 3 months of age
    More Guidelines
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