Pediatric emergency medicine trisk 3768 3768

Pyloric Stenosis
Goals of Treatment
Pyloric stenosis is not a surgical emergency, but proper diagnosis and correction
of electrolyte abnormalities are important for rapid recovery of the infant.
CLINICAL PEARLS AND PITFALLS
Pyloric stenosis leads to nonbilious emesis only
Pyloric stenosis may present with hematemesis
Severe metabolic alkalosis can lead to apnea
Very early in the course of pyloric stenosis, ultrasound diagnosis based
on measurements may be falsely reassuring; repeat US should be
performed if symptoms persist
Current Evidence
Pyloric stenosis refers to an idiopathic hypertrophy of the pyloric muscle and
occurs in 1 in 250 births. There is a male:female ratio of 4:1, and first born males
are at higher risk. A familial incidence has been shown, particularly if the mother
had hypertrophic pyloric stenosis as an infant. The age of onset is usually 2 to 5
weeks. Rarely, the onset may be late in the second month of life. The cause of the
muscle hypertrophy is unknown, but the symptoms, diagnosis, and therapy are
well defined.
Clinical Considerations
Initial Assessment. Characteristically, the infant does well, without vomiting, for
the first few weeks of life and then starts vomiting, either at the end of feedings or
within 30 minutes. The infant is hungry and will eat immediately after vomiting.
The vomiting becomes more prominent and eventually becomes forceful,
projectile emesis. The vomitus is always nonbilious. With protracted emesis,
hematemesis can occur. Infants with pyloric stenosis may also become jaundiced
with the onset of the other symptoms. The hyperbilirubinemia usually improves
or abates postoperatively for reasons that are unknown.
Early in the course, infants may appear perfectly active and well hydrated. In
infants with protracted symptoms, moderate to severe dehydration may exist. The
abdomen is soft and nondistended and if the infant is relaxed, an “olive” mass

may be palpable in the midepigastrium. Sugar water can be used to help relax the