Hypertrophic Pyloric Stenosis

Hypertrophic stenosis is a condition in which the pyloric muscle around the lower part of the stomach leading to the intestines becomes larger than normal. This causes the outlet of the stomach to become narrow, making it difficult for the stomach to empty its contents into the intestines.

Hypertrophic pyloric stenosis is a pediatric disorder that occurs between the ages of two weeks and five months. It is more common in male children and full term infants are more likely to be affected than premature infants. The cause of hypertrophic pyloric stenosis is unknown.

Symptoms of Hypertrophic Stenosis

A child with this condition will show the following signs:

constipation or a decrease in bowel movements because food fails to reach the intestines.
failure to gain weight or weight loss.
excessive hunger.
dehydration as evidenced by fewer wet diapers than normal for the baby or a decrease in urinating, crying without tears and weakness or fatigue.
yellowing of the eyes.

The cardinal sign of hypertrophic stenosis is projectile vomiting, where the infant vomits forcefully about 30 minutes after eating. The contents of the vomit may travel up to 30 feet away from the child. It may start off as spitting up which eventually increases in frequency and intensity. Vomiting occurs after a meal and along with the initial food contents eaten, there may be blood in the vomit. Wave-like motions may be seen on the stomach after an episode of vomiting.

Hypertrophic Stenosis Treatment

Initial medical management of hypertrophic pyloric stenosis is focused rehydrating the infant. Corrective surgery then follows once the child is sufficiently hydrated. The surgical procedure for this disorder is called pyloromyotomy and is aimed at reducing the size of the pyloric muscle.

Pyloromyotomy may be done by making an open incision around the infants navel to visualize and work on the enlarged pyloric muscle or by inserting a laparoscope (a viewing instrument which has small surgical instruments and a laser attached to it) into a little incision made near the infant's navel. The laparoscopic procedure leaves a smaller scar and is as safe and effective as the open procedure.

What to Expect After Treatment

The pyloric muscle returns to its normal size about 12 weeks after surgery. Some vomiting will occur postoperatively but should stop after about 48 hours. Symptoms of hypertrophic pyloric stenosis are usually absent 24 hours after surgery and postoperative complications that may occur include a leak in the intestines or stomach due to perforation, infection of the incisions and persistent vomiting.

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