Incidence
2.2 in 1000 live births
Ratio
4male: 1 female
Associations:
Caucasians, born in autumn and spring, bottle fed
Aetiology:
unknown , lack of nitrous oxide secondary to decrease synthesis of
nitrous oxide synthease =>failure of relaxation of pylorus =>sustained
contraction of sphincter =>hypertrophy of muscle.
?
Vasoactive intestinal polypeptide
Pathology
macro = elongated thickened firm non
compressible pylorus
Body and
fundus dilated forceful+visible contractions
Micro
hypertrophy of circular muscle layer +attenuated longitudinal
muscle
histo
marked reduction in neural element in hypertrophied circular muscle
Clinical
picture
pmhx
unremarkable
Usual
presentation
3-6
weeks c/o vomiting
progressive frequent severe ,Forceful projectile
Desperately
Hungary crying for feed, Vomiting after feed consisting of ingested milk
Not bile
stained
Dehydration
electrolyte imbalance wt loss
smalldry
greenous stools starvation stools, urine concentrated
LUQ +epigastric
distension and discomfort
On
examination
(feed
+n/g aspirate continuously)
Mobile
firm smooth nontender supraumblical right hypochondria mass
palpable
mass => diagnosis
Investigation:
Ultrasound
confirms diagnosis
Contrast
x-rays
Labs:
increased urea, PCV
Decreased Na K Cl
Alkalosis and acidic urine
(Hypochloremic hypokalemic alkalosis)
Management:
N/G asp,
Sham feed,
Fluids & electrolytes corrections
Treatment:
ramsted’s pyloromyotomy only acceptable treatment
Balloon
dilatation inappropriate ineffective
Approach:
(midline, paramedin no longer acceptable )
1
transverse RT upper quadrant
2 circum
umbilical supra umbilical incision
3
laproscopic pyloromyotomy (complication CO2 pneumoperitoneum)
Complications
Mucosal perforation ,
Wound infection
Post
op
1
feeding is rapidly started within few hours (as soon as baby starts to cry)
2
Perforation: feed delayed for 3-5 days