Summary
Definition
History and exam
Key diagnostic factors
- first-born male infant
- nonbilious projectile vomiting
- 2 to 12 weeks old
- upper abdominal mass
- peristaltic waves
Other diagnostic factors
- family history of pyloric stenosis
- multiple formula changes
- tachycardia
- decreased wet diapers
- dry mucous membranes
- flat or depressed fontanelles
- constipation
- poor weight gain
- irritability
Risk factors
- prematurity
- early exposure to erythromycin
- exposure to prostaglandins
- maternal exposure to macrolides
- geographic location/ethnic background
- first-born male infant
- family history of pyloric stenosis
Diagnostic investigations
1st investigations to order
- chemistry panel
- ultrasound abdomen
Treatment algorithm
all patients
Contributors
Authors
Catherine J. Hunter, MD
Professor of Surgery and Division Chief of Pediatric Surgery
Oklahoma Children’s Hospital
The University of Oklahoma College of Medicine
Oklahoma City
OK
Disclosures
CJH declares that she has no competing interests.
Acknowledgements
Dr Catherine Hunter would like to gratefully acknowledge Dr Samuel C. Klonoski, Dr Jeffrey S. Upperman, Dr Yigit S. Guner, and Dr Arturo Aranda, previous contributors to this topic. SCK, 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 (Paediatric Surgery)
Consultant in Paediatric and Neonatal Surgery
Royal Alexandra Children's Hospital
Brighton
UK
Disclosures
RH declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. 2007 Feb;16(1):27-33. Abstract
Expert Panel on Pediatric Imaging., Alazraki AL, Rigsby CK, et al. ACR Appropriateness Criteria® Vomiting in infants. J Am Coll Radiol. 2020 Nov;17(11s):S505-S515.Full text Abstract
Staerkle RF, Lunger F, Fink L, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis. Cochrane Database Syst Rev. 2021 Mar 9;3:CD012827.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Gastroesophageal reflux
- Overfeeding
- Malrotation
More DifferentialsGuidelines
- ACR appropriateness criteria: vomiting in infants
More Guidelines
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