Hypertrophic pyloric stenosis

Hypertrophic pyloric stenosis
Updated: 02/22/2019
© Jun Wang, MD, PhD

General features
  • Obstruction of gastric outlet due to pylorus sphincter muscle hypertrophy
  • Most common cause of intestinal obstruction in infancy
  • More common in males, white
  • Commonly associated hyperbilirubinemia, midgut malrotation
Pathogenesis
  • Deficiency of nitric oxide synthase containing neurons
  • Abnormal myenteric plexus innervation
  • Infantile hypergastrinemia
  • Certain medications such as macrolide antibiotics
  • Lack of vasoactive intestinal polypeptide
Clinical presentations
  • Immediate postprandial nonbilious forceful vomiting
  • Regurgitation
  • Emaciation and dehydration
  • Olive-like mass the right upper lateral edge of rectus abdominis, best palpated after infant has vomited and calm
  • Gastric peristalsis prior to emesis
Radiologic findings
Treatment
  • Surgery: pyloromyotomy
  • Fluid and electrolyte management


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