Pyloric stenosis is a condition affecting infants where the muscle at the stomach’s outlet, the pylorus, thickens and narrows. This narrowing obstructs food from passing into the small intestine.
Understanding the Urgency
Pyloric stenosis is considered a medical emergency. The progressive thickening of the pylorus prevents digested food from moving out of the stomach, leading to significant health concerns in infants. This obstruction results in persistent vomiting, which can quickly cause dehydration, an imbalance in the body’s essential minerals (electrolytes), and malnutrition. Timely intervention is important, as delayed treatment can lead to severe dehydration and undernourishment.
Recognizing the Signs
A key symptom of pyloric stenosis is forceful, projectile vomiting, which can send breast milk or formula several feet away. This vomiting typically occurs after feeding, but the infant often remains hungry and eager to feed again almost immediately. As the condition progresses, infants may experience weight loss or a failure to gain weight due to the inability to retain nutrients.
Signs of dehydration can also become apparent, including fewer wet diapers, a sunken soft spot on the head (fontanelle), lethargy, and a dry mouth. Parents might observe wavelike ripples or contractions across the baby’s upper abdomen after feeding, just before vomiting, as the stomach muscles try to push food through the narrowed opening. In some instances, a small, olive-shaped lump, which is the thickened pylorus, might be felt in the upper abdomen.
Diagnosis and Treatment
Diagnosing pyloric stenosis typically begins with a thorough physical examination, where a doctor might feel for the characteristic “olive” mass or observe abdominal contractions. An abdominal ultrasound is the primary imaging test used to confirm the diagnosis, allowing visualization of the thickened pyloric muscle. Blood tests are also performed to assess for dehydration and electrolyte imbalances, which are common due to persistent vomiting.
The definitive treatment for pyloric stenosis is a surgical procedure called a pyloromyotomy. During this operation, a surgeon makes an incision through the outer, thickened muscle layers of the pylorus, carefully avoiding the inner lining. This incision widens the passageway, allowing food to move freely from the stomach into the small intestine. This procedure is successful in resolving the condition.
Recovery and Outlook
Following a pyloromyotomy, infants typically have a short hospital stay, often one to two days. Feedings are gradually reintroduced, usually starting with clear fluids and then progressing to breast milk or formula within 12 to 24 hours after the procedure. Some vomiting may still occur in the immediate post-operative period as the digestive system adjusts, but this usually improves quickly. The long-term prognosis after surgical correction is favorable. Most infants recover fully and experience no lasting complications from pyloric stenosis once treated.