Pyloric stenosis
Pyloric stenosis is a gastrointestinal condition in infants characterized by an obstruction of the stomach due to muscular hypertrophy at the gastric outlet. Although the exact cause remains unclear, symptoms typically manifest within the first few weeks of life, with nonbilious projectile vomiting being the most prominent. This vomiting can result in dehydration and poor growth if not treated. Diagnosis often involves palpating a firm mass in the mid-upper abdomen, although imaging techniques like ultrasound may also be used for confirmation.
Treatment begins with the correction of dehydration through intravenous fluids, followed by a surgical procedure known as pyloromyotomy. This operation involves making an incision to remove the pyloric mass and split the pyloric muscle, allowing for normal gastric emptying. Postoperative recovery is generally swift, with most infants resuming feeding within 24 hours. Pyloric stenosis, first described in the late 18th century, has seen significant advancements in treatment, making the surgical intervention highly effective with low complication rates. Understanding this condition can help caregivers recognize symptoms early and seek appropriate medical attention.
Pyloric stenosis
ANATOMY OR SYSTEM AFFECTED: Gastrointestinal system, stomach
DEFINITION: An obstruction of the stomach in infancy caused by muscular hypertrophy of the gastric outlet
CAUSES: Unclear
SYMPTOMS: Stomach obstruction, projectile vomiting, dehydration, poor growth
DURATION: Typically short-term
TREATMENTS: Intravenous fluids, surgical removal of obstruction
Causes and Symptoms
The exact cause of pyloric stenosis is unknown. The condition is usually characterized by nonbilious projectile vomiting beginning at three weeks of age, although it may occur as early as the first week of life or as late as five months of age. The is progressive and leads to poor growth and dehydration. Initially, the vomit resembles the that the infant ingested, but it may become brownish in later stages of the disease.
Treatment and Therapy
Pyloric is diagnosed through palpation of a small, firm mass, similar to the size and shape of an olive, in the mid-upper abdomen. This mass is not palpable in all infants with pyloric stenosis. In these cases, imaging procedures such as an upper (GI) series or ultrasound of the upper can confirm the diagnosis.
The initial treatment of pyloric stenosis involves correction of dehydration with intravenous fluids. The surgical treatment is called a pyloromyotomy. After the infant is anesthetized, an incision is made in the right-upper abdomen, through which the pyloric mass is removed. The pyloric muscle is split down to the mucosa, or lining of the stomach. Postoperative vomiting is common and is probably caused by slow emptying of fluids from the stomach. The vomiting usually resolves, however, such that the infant may resume feeding within twenty-four hours after surgery, with advancement to regular feeding within two days. This operation is usually curative, with low and rates.
Perspective and Prospects
Pyloric stenosis was first described in 1788. Harald Hirschsprung coined the term “congenital hypertrophic pyloric stenosis” in 1888. At that time, approximately one-fourth of infants affected by pyloric stenosis died without treatment, while more than half of the infants with this condition died after surgery. A significant advance in the treatment of pyloric stenosis came in 1912 when Conrad Ramstedt reported performing a pyloromyotomy. The procedure that he described remains the standard treatment.
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