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.

** WARNING: GRAPHIC IMAGES **

Treatment is generally surgical. A small incision is made in the right upper abdomen and the enlarged pylorus is brought out through the wound. An incision is made only in the outer muscular later. The cut edges of tissue are then spread apart in order to allow the mucosa (inner lining of the channel) to buldge out and allow passage of milk once again.

Although the baby still appeared weak, we finally took her to the operating room once she had enough IV fluids and she was making urine. The surgery went well and the nurses were very attentive to her post-operatively. Within 6 hours, we allowed her to start taking small amount of breastmilk. She vomited 2 more times and then vomiting ceased.

She stayed in the hospital about 1 week and then was ready for discharge home.

She came back to see me and is doing great!

 

Comments