Pyloric Stenosis
Hirschsprung described in 1880s
Presents in first month
M:F =5:1 (esp. first born males)
Strong FHx
Signs and Symptoms
- Vomiting (+/- projectile)
- Hungry infant who vomits soon after eating
- Bilious vomiting very rarely
- Peristaltic wave from left to right after feeding
- Eventual dehydration and constipation
- Jaundice may ensue (1-2%)
- Mass in RUQ beside rectus muscle
Investigations
- Dehydration
- Hypokalemic, hypochloremic metabolic alkalosis
- Ultrasound
- Increased diameter (>17mm) & wall thickness (14mm)
- “String sign” from narrow pylorus
Management
- ABC’s
- NPO/ NG suction
- Fluid resuscitation
- Surgery (may delay repair up to 48hrs to rehydrate)
