INFANTILE HYPERTROPHIC PYLORIC STENOSIS
It is hypertrophy of musculature of pyloric antrum, especially the circular muscle fibres, causing primary failure of pylorus to relax. Duodenum is normal. There is increased risk of developing the condition if newborn gets erythromycin or azithromycin in first 14 days after birth.
- Common in first born males (4:1).
- Incidence is 4 in 1000 births.
- It is familial.
- It is seen between 3rd and 6th weeks of age of an infant, the
- time taken by the hypertrophied muscle to cause complete
- Vomiting—forcible, projectile and non-bilious.
- Visible gastric peristalsis (VGP).
- Palpable lump of hypertrophied pylorus which is better felt
- from left side, as a mobile, smooth, firm, olive like mass,
- with all borders well made out, moves with respiration, with
- impaired resonance on percussion. It is the most important
- clinical feature (95%).
- Dehydration and loss of weight.
- Electrolyte imbalance—hypokalaemic metabolicalkalosis.
ULTRASOUND ABDOMEN —Doughnut sign.
Pyloric muscle 4 mm or more in thickness.
Length of pyloric canal >14 mm.
Cervix sign on long axis, target sign on short axis.
Barium meal shows obstruction.
Contrast study is not commonly done; but when it is done, it shows ‘string sign’ or ‘railroad track sign’ or ‘double track sign’ with pyloric obstruction.
- Correction of dehydration and electrolyte imbalance.
- Ramstedt’s operation—
- Laparoscopic pyloromyotomy is becoming popular.
- Endoscopic pyloromyotomy
- Balloon dilatation