Pyloric Stenosis

Pyloric stenosis is the narrowing of the lower portion of the stomach (pylorus) that leads into the small intestine. The muscles in this part of the stomach thicken, narrowing the opening of the pylorus and preventing food from moving from the stomach to the intestine.

This problem typically occurs in infants between 2 and 8 weeks of age and affects one out of every 500 to 1,000 live births.

Since the stomach opening becomes blocked, food cannot move into the intestine. This causes a baby with pyloric stenosis to vomit forcefully after eating. As a result of this vomiting, several problems can arise.

The most serious problem is dehydration (excessive water loss from the body). A baby who vomits regularly will not get sufficient fluids to meet his / her nutritional needs.

Additionally, minerals that the body needs to stay healthy, such as potassium and sodium, are lost through vomiting. Lacking an adequate amount of both water and minerals can cause infants to lose weight and to become extremely sick very quickly.

No particular cause of pyloric stenosis has been clearly identified, though both genetic and environmental factors are thought to be involved. It is known, however, that there is nothing that can be done to prevent its occurrence.

Pyloric stenosis is considered a multifactorial trait, which means that many factors are involved. In many defects with multifactorial traits, one gender is affected more frequently than the other. For example, pyloric stenosis is four times more common in males than in females.

In families where one child has pyloric stenosis, there is an increased risk that a future brother or sister could also have this condition. Adults who have had pyloric stenosis when they were infants may pass the trait on to their children.

If a child with pyloric stenosis is female:

  • The likelihood of having a future son with pyloric stenosis is 1 in 5
  • The likelihood of having a future daughter with pyloric stenosis is 1 in 14

If a child with pyloric stenosis is male:

  • The likelihood of having a future son with pyloric stenosis is 1 in 20
  • The likelihood of having a future daughter with pyloric stenosis is 1 in 40

Other pyloric stenosis risk factors:

  • Caucasians seem to develop pyloric stenosis more frequently than babies of other races.
  • Due to the hereditary factor, several members of a family may have had this problem in infancy.

The most common symptom of pyloric stenosis is forceful, projectile vomiting, which is quite different from a "wet burp" that a baby may have at the end of a feeding. The baby is usually quite hungry and eats or nurses eagerly.

Large amounts of breast milk or formula are then vomited and may go several feet across a room. The milk is sometimes curdled in appearance due to the fact that it remains in the stomach where it is exposed to acid.

Other symptoms include:

  • Weight loss
  • Dehydration
  • Lethargy (lack of energy)
  • Fewer bowel movements
  • Constipation
  • Mild jaundice (yellowish coloring in skin)

Careful physical examination generally reveals a firm mass, the size of an olive, in the mid-abdomen. Your physician may advise other diagnostic procedures to confirm the diagnosis and to eliminate conditions with symptoms similar to those seen in babies with pyloric stenosis. These procedures include:

  • Blood tests – These are done to evaluate dehydration and mineral imbalances.
  • Abdominal ultrasound -- This is the gold standard for diagnosing pyloric stenosis. This is an imaging technique that uses high frequency sound waves and a computer to create images of blood vessels, tissues, and organs. It is used to determine the thickness and length of the pyloric muscle.
  • Barium swallow / upper GI series – This test examines the organs comprising the upper part of the digestive system, which are the esophagus, stomach, and duodenum (the first section of the small intestine). A dense, chalky fluid called barium, which is used to coat the inside of organs so they will show up on an X-ray, is swallowed. X-rays are then taken to evaluate the digestive organs. This test will also demonstrate a delayed emptying of the stomach content as well as the narrowing of the pylorus.

Pyloric stenosis is treated in two stages. First, fluids are given intravenously to treat dehydration and restore the body's normal chemistry.

Once this is done, an operation called a pyloromyotomy is performed. This opens up the tight muscle that has caused the narrowing in the stomach, allowing the passage of food from the stomach to the intestine.

This surgery can be performed using either an open or laparoscopic surgical approach.

Pain

While in the operating room, your baby will receive a pain medication that is injected into the incision. This should allow him/her to feel and appear comfortable for about six to eight hours after surgery. If necessary, acetaminophen (medication such as Tylenol) may also be given to help ease discomfort.

Feedings

Within two hours after surgery, small amounts of milk or liquids are given. Over a 24- to 48-hour period, feedings are gradually increased. As soon as your baby can tolerate normal feedings (usually one to two days after surgery), he/she will be discharged from the hospital. After discharge, it is strongly recommended to do no more than 3 ounces every three hours for the next three days.

Vomiting

Although a baby often vomits for 24 to 48 hours after surgery, this usually disappears without any further treatment. Occasionally, however, vomiting may persist for four to five days.

Incision

Your baby's incision should be kept clean and dry, and no tub baths should be given for one week after surgery. Steri-strips (bandage-like tape) that are placed over the incision should be left in place and then removed according to the instructions of your pediatric surgeon. They are generally left in place for seven to 10 days.

  • Your baby's temperature is above 101° F (38.6° C), even if it drops below this when acetaminophen is given.
  • There is an increase in redness, swelling or drainage at the incision site or if this site has drainage with a foul odor.
  • Pain is not relieved by medication.
  • There are signs of dehydration such as fewer wet diapers each day, the absence of tears when crying, or a fontanel (soft spot on the head) that appears sunken.
  • Vomiting occurs with more than three consecutive feedings or lasts longer than 48 hours after discharge.

There are no long-term effects of surgery, and there is less than a 1 percent chance that pyloric stenosis will recur.


Last Updated 12/2013