Pyloric Stenosis Overview

Pyloric stenosis (infantile hypertrophic pyloric stenosis) is a condition that causes severe vomiting in the first few months of life. Pyloric stenosis can occur any time between birth and 5 months of age. Pyloric stenosis is a narrowing of the pylorus, the lower part of the stomach through which food and other stomach contents pass to enter the small intestine. When an infant has pyloric stenosis, the muscles in the pylorus have become enlarged to the point where food is prevented from emptying out of the stomach. It affects about three out of 1,000 babies in the United States.

Symptoms

Babies with this condition usually present any time in the first weeks to months of life with progressively worsening vomiting. The vomiting is often described as non-bile stained ("non bilious") and "projectile vomiting", because it is more forceful than the usual spittiness (gastroesophageal reflux) seen at this age.

Pyloric stenosis occurs more commonly in Caucasian infants than in babies of other ethnic backgrounds, and affected infants are more likely to have blood type B or O. The causes of pyloric stenosis are unknown, but genetic factors may play a role. Antibiotics, such as erythromycin, given to a baby within the first 2 weeks of life may slightly increase his or her chances for developing pyloric stenosis. Most infants who develop pyloric stenosis are usually between 2 weeks and 2 months of age - symptoms usually appear during or after the third week of life. The first symptom of pyloric stenosis is usually vomiting. Some infants present with poor feeding and weight loss, but others demonstrate normal weight gain. Dehydrated infants are lethargic and less active than usual.

How is pyloric stenosis treated?

If a diagnosis of pyloric stenosis is made, the baby will have some blood work done to check for dehydration. A catheter will be placed into the vein (IV) to replace fluids that the baby needs. The baby may go to surgery that day or the following day. It is very important that the baby not drink anything until after surgery.

The operation is called a pyloromyotomy (pie-lore-oh-my-ot-toe-me). This operation spreads open the muscle around the pyloric valve of the stomach. The incision is about 1 inch long either right around the belly button or on the right hand side of the abdomen. Stitches that dissolve are used, so they won’t have to be removed later.

What is the recovery time for pyloric stenosis surgery?

Babies can often begin drinking small amounts of clear liquids in the first 24 hours. Generally, clear liquids such as an electrolyte drink will be given to your baby first.

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