Pyloric stenosis

Pyloric Stenosis
Outline of stomach, showing its anatomical landmarks, including the pylorus.
SpecialtyGeneral surgery
SymptomsProjectile vomiting after feeding[1]
ComplicationsDehydration, electrolyte problems[1]
Usual onset2 to 12 weeks old[1]
CausesUnknown[2]
Risk factorsCesarean section, preterm birth, bottle feeding, first born[3]
Diagnostic methodphysical examination,[1] ultrasound[4]
Differential diagnosisGastroesophageal reflux,[1] intussusception[5]
TreatmentSurgery[1]
PrognosisExcellent[1]
Frequency1.5 per 1,000 babies[1]

Pyloric stenosis is a narrowing of the opening from the stomach to the first part of the small intestine (the pylorus).[1] Symptoms include projectile vomiting without the presence of bile.[1] This most often occurs after the baby is fed.[1] The typical age that symptoms become obvious is two to twelve weeks old.[1]

The cause of pyloric stenosis is unclear.[2] Risk factors in babies include birth by cesarean section, preterm birth, bottle feeding, and being firstborn.[3] The diagnosis may be made by feeling an olive-shaped mass in the baby's abdomen.[1] This is often confirmed with ultrasound.[4]

Treatment initially begins by correcting dehydration and electrolyte problems.[1] This is then typically followed by surgery, although some treat the condition without surgery by using atropine.[1] Results are generally good in both the short term and the long term.[1]

About one to two per 1,000 babies are affected, and males are affected about four times more often than females.[1] The condition is very rare in adults.[6] The first description of pyloric stenosis was in 1888, with surgical management first carried out in 1912 by Conrad Ramstedt.[1][2] Before surgical treatment, most babies with pyloric stenosis died.[1]

  1. ^ a b c d e f g h i j k l m n o p q r s Ranells JD, Carver JD, Kirby RS (2011). "Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update". Advances in Pediatrics. 58 (1): 195–206. doi:10.1016/j.yapd.2011.03.005. PMID 21736982.
  2. ^ a b c Georgoula C, Gardiner M (August 2012). "Pyloric stenosis a 100 years after Ramstedt". Archives of Disease in Childhood. 97 (8): 741–5. doi:10.1136/archdischild-2011-301526. PMID 22685043. S2CID 2780184.
  3. ^ a b Zhu J, Zhu T, Lin Z, Qu Y, Mu D (September 2017). "Perinatal risk factors for infantile hypertrophic pyloric stenosis: A meta-analysis". Journal of Pediatric Surgery. 52 (9): 1389–1397. doi:10.1016/j.jpedsurg.2017.02.017. PMID 28318599.
  4. ^ a b Pandya S, Heiss K (June 2012). "Pyloric stenosis in pediatric surgery: an evidence-based review". The Surgical Clinics of North America. 92 (3): 527–39, vii–viii. doi:10.1016/j.suc.2012.03.006. PMID 22595707.
  5. ^ Marsicovetere P, Ivatury SJ, White B, Holubar SD (February 2017). "Intestinal Intussusception: Etiology, Diagnosis, and Treatment". Clinics in Colon and Rectal Surgery. 30 (1): 30–39. doi:10.1055/s-0036-1593429. PMC 5179276. PMID 28144210.
  6. ^ Hellan M, Lee T, Lerner T (February 2006). "Diagnosis and therapy of primary hypertrophic pyloric stenosis in adults: case report and review of literature". Journal of Gastrointestinal Surgery. 10 (2): 265–9. doi:10.1016/j.gassur.2005.06.003. PMID 16455460. S2CID 25249604.