Pyloric stenosis

Pyloric stenosis is a benign condition associated with recurrent projectile nonbilious vomiting, typically in a 2- to-12-week-old male infant.

Features may include a history of feeding intolerance with multiple formula changes.

Failure to thrive/weight loss may progress to increasing volume depletion. An olive-shaped mass may be palpable in the right upper abdomen.

Ultrasound shows pyloric channel length >15 mm and pyloric muscle thickness >3 mm.

Treatment is with intravenous fluid and electrolyte replacement, followed by pyloromyotomy (open or laparascopic).

Complications of pyloromyotomy include wound infection, gastric or duodenal mucosal perforation, or incomplete myotomy.

In pyloric stenosis, hypertrophy of the pyloric sphincter results in narrowing of the pyloric canal. It is the most common cause of gastric outlet obstruction in the 2- to 12-week-old age group, and leads to progressive and projectile vomiting.[1]Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. 2007 Feb;16(1):27-33. http://www.ncbi.nlm.nih.gov/pubmed/17210480?tool=bestpractice.com [2]Donda K, Asare-Afriyie B, Ayensu M, et al. Pyloric stenosis: national trends in the incidence rate and resource use in the United States from 2012 to 2016. Hosp Pediatr. 2019 Dec;9(12):923-32. https://publications.aap.org/hospitalpediatrics/article/9/12/923/26750/Pyloric-Stenosis-National-Trends-in-the-Incidence?autologincheck=redirected http://www.ncbi.nlm.nih.gov/pubmed/31748239?tool=bestpractice.com ​[3]Jobson M, Hall NJ. Contemporary management of pyloric stenosis. Semin Pediatr Surg. 2016 Aug;25(4):219-24. http://www.ncbi.nlm.nih.gov/pubmed/27521712?tool=bestpractice.com ​[4]Ranells JD, Carver JD, Kirby RS. Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update. Adv Pediatr. 2011;58(1):195-206.​ Pyloric stenosis may also be referred to as infantile hypertrophic pyloric stenosis (IHPS) or hypertrophic pyloric stenosis (HPS).