The Hauns in Africa

Pyloric Stenosis

A 10 week old baby girl was admitted to the hospital for vomiting, dehydration and failure to thrive. She was still only 3.5 Kg (about 7lb, 11 oz)! From the history given by the mother, there were no problems with the birth. About one week later, however, the baby started to vomit. She would nurse well, then vomit and want to nurse again. She had been admitted to another district hospital for 2 weeks, but saw no improvement, so she was brought to BMC.

We resuscitated her by giving her fluids intravenously and monitoring her ability to make urine.

On exam, her abdomen was soft, not severely distended and no masses were felt. We followed up the exam with an ultrasound. I found that her muscle around the pylorus (the special channel between the stomach and the first part of the small intestines) was much larger than it should be. The pathway between the two organs was limited to a trickle.

The condition is called Hypertrophic Pyloric Stenosis. It is usually found by week 4-6 after birth, but sometimes, diagnosis is delayed around here.  The problem arises when the pyloric muscle grows very thick and essentially blocks the pyloric channel, thereby causing the baby to vomit – even projectile vomiting.

Drilling Bone for Granulation Tissue

A boy was bit by a snake on the shin and the bite developed into a large abscess with significant loss of tissue. As the healing began, about 75% of the anterior tibia was exposed. The infection was now gone, but now the problem was healing an exposed bone.

As wounds heal, granulation tissue covers the wound. Colloquially, it is called “proud flesh.”