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A 4-week-old infant presented for pyloromyotomy. The patient had a 3-day history of nonbilious, projectile vomiting.
What is pyloric stenosis?
Pyloric stenosis is caused by circular muscular hypertrophy at the pylorus. It produces gastric outlet obstruction. Pyloric stenosis usually manifests between 2 and 6 weeks of age but can manifest earlier. There is a higher incidence in male infants.
What is the clinical presentation of pyloric stenosis?
Symptoms may begin with regurgitation, which progresses to nonbilious, projectile vomiting. Jaundice may occur in 5% of infants secondary to hepatic gluconyltransferase deficiency. Jaundice usually resolves after treatment.
How is the diagnosis made?
On physical examination, an olive-like mass can be palpated in the epigastrium just right of the midline. The diagnosis can be confirmed either by ultrasound or by barium swallow. However, barium swallow adds to the risk of aspiration pneumonitis in the perioperative period.
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