Pyloric stenosis is a condition that usually occurs in firstborn baby boys, between the age of three to six weeks old. The main symptom of pyloric stenosis is persistent and progressively worsening vomiting in an otherwise well baby.
What is the cause of pyloric stenosis?
When food enters the stomach it contracts and churns the food for easier digestion. Normally, the food then passes through the stomach into the small intestine. At the end or outlet of the stomach leading into the small intestine is the pylorus, which is a muscular, elastic-like area. In Pyloric Stenosis, for reasons not well understood, the pyloris is too big or hypertrophied. In other words, the pyloric muscle gets too thick and actually blocks the food from leaving the stomach. This results in persistent vomiting which continues to worsen unless the problem is treated.
The symptoms of pyloric stenosis
Generally babies with pyloric stenosis are initially otherwise well, without any fever, pain or other symptoms. In fact, they are often quite hungry. The main symptom which is highly suggestive of pyloric stenosis is projectile vomiting. This means that vomit is "ejected" quite far from the baby with great force. The stomach is contracting and trying to push the food into the intestine, but the food is blocked by the enlarged pyloris so it is pushed out in reverse or upwards.
How is pyloric stenosis confirmed?
Usually the history of the projectile vomiting in a 3-6 week old otherwise well baby boy raises high suspicions. On physical examination, the doctor may find signs of dehydration, and may actually notice the baby's abdomen is distended or ballooning because the stomach is stretched. Sometimes the doctor may actually feel the olive-like pyloris while examining the baby's belly. An x-ray and ultrasound will confirm the diagnosis. Blood tests will be taken to asses the degree of dehydration.
How is pyloric stenosis treated?
The only definitive treatment of pyloric stenosis is an operation called a pyloromyotomy. Before surgery, the baby is given fluids through an intravenous and is not allowed to feed. A tube may be inserted into the stomach through the nose to relieve the distension or bloated abdomen. During the operation, the surgeon cuts and removes the excess muscle of the pyloris, unblocking the stomach and thus resolving the problem. The operation lasts less than an hour and the babies usually recover fully very quickly. The baby can usually start feeding 6-8 hours after the operation.
Fortunately almost all babies do very well after the operation and have no recurrence nor long term consequences.