Pyloric stenosis is a problem that affects babies between birth and 6 months of age and causes forceful vomiting that can lead to dehydration. It is the second most common problem requiring surgery in newborns.
The lower portion of the stomach that connects to the small intestine is known as the pylorus. In pyloric stenosis, the muscles in this part of the stomach enlarge, narrowing the opening of the pylorus and eventually preventing food from moving from the stomach to the intestine.
What causes pyloric stenosis?
Pyloric stenosis is considered a multifactorial trait. Multifactorial inheritance means that many factors are involved in causing a birth defect. The factors are usually both genetic and environmental. Often one gender (either males or females) is affected more frequently than the other in multifactorial traits. There appears to be a different threshold of expression, which means that one gender is more likely to show the problem, over the other gender. For example, pyloric stenosis is four times more common in males than females. Once a child has been born with pyloric stenosis, the chance for it to happen again depends on the gender of the child already born with the condition, as well as the gender of the next child.
Which babies are at higher risk for pyloric stenosis?
- Whites seem to develop pyloric stenosis more frequently than babies of other races.
- Boys develop pyloric stenosis more often than girls.
- Pyloric stenosis may be inherited; several members of a family may have had this problem in infancy.
Why is pyloric stenosis of concern?
Because the stomach opening becomes blocked and babies start vomiting, several problems can happen. The most serious problem is dehydration. When a baby vomits regularly, he or she will not get enough fluids to meet his or her nutritional needs. Babies have smaller bodies than adults and cannot tolerate losing fluid as easily as adults can. Minerals that the body needs to stay healthy, such as potassium and sodium, are also lost as the baby vomits. Babies who lack the right amount of water and minerals in their bodies can become very sick very quickly.
Another problem that occurs is weight loss. A baby who vomits most of (or all of) his or her feedings will not have adequate nutrition to gain weight and stay healthy.
What are the symptoms of pyloric stenosis?
The most common symptoms noted in a baby with pyloric stenosis is forceful, projectile vomiting. This kind of vomiting is different from a "wet burp" that a baby may have at the end of a feeding. Large amounts of breast milk or formula are vomited, and may go several feet across a room. The baby is usually quite hungry and eats or nurses eagerly. The milk is sometimes curdled in appearance, because as the milk remains in the stomach and does not move forward to the small intestine, the stomach acid "curdles" it.
Other symptoms may include:
- Weight loss
- Ravenously hungry despite vomiting
- Lack of energy
- Fewer bowel movements
- Frequent, mucous stools
The symptoms of pyloric stenosis may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.
How is pyloric stenosis diagnosed?
Careful physical examination generally reveals a firm mass, the size of an olive, in the mid-abdomen. Your physician may order other diagnostic procedures to confirm the diagnosis and to eliminate conditions with symptoms similar to those seen in babies with pyloric stenosis.
These procedures include:
- Blood tests. These tests evaluate dehydration and mineral imbalances.
- Abdominal X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Abdominal ultrasound. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- Barium swallow/upper GI series. A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
What is the treatment for pyloric stenosis?
Specific treatment for pyloric stenosis will be determined by your baby's doctor based on:
- Your baby's gestational age, overall health, and medical history
- The extent of the problem
- Your baby's tolerance for specific medications, procedures, or therapies
- Expectation for the course of the problem
- Your opinion and preference
Pyloric stenosis must be repaired with an operation. However, doctors may need to treat your baby's dehydration and mineral imbalances first. Water and minerals can be replaced through intravenous (IV) fluid.
Once your baby is no longer dehydrated, surgery can be performed. Under anesthesia, a small incision is made above the navel and the tight pyloric muscle is repaired.
While in the operating room, your baby will receive a pain medication that is injected into the incision. This should allow him/her to feel and appear comfortable for about 6 to 8 hours after surgery. If necessary, infant acetaminophen (Tylenol) may also be given as needed to help ease discomfort. There is generally not a lot of pain for the baby after the operation. When you go home, you may give infant Tylenol every 4-6 hours as needed for the first 24-48 hours.
What is the recovery time for pyloric stenosis surgery?
Babies can often begin drinking small amounts of clear liquids in the first 24 hours. Generally, clear liquids, such as an electrolyte drink, will be given to your baby first. However, babies may still vomit for several days after surgery due to swelling of the surgical site of the pyloric muscle. The swelling goes away within a few days.
Most babies will be taking their normal feedings by the time they go home. Babies are usually able to go home within two to three days after the operation. There are no activity restrictions following this operation.
Incision Care / Bathing
Your baby's incision/incisions should be kept clean and dry. You may give your baby shallow baths or sponge bathe your baby following the surgery. The incisions should not be submerged in a tub bath should for the first two weeks after surgery. Steri-strips (bandage-like tapes) or surgical glue are placed over the incision and should be left in place until they fall off on their own or the glue sloughs off by itself. They are generally left in place for 7 to 10 days.
When to contact the surgeon
- If your baby's temperature is above 101° F (38.6° C)
- There is an increase in redness, swelling or drainage at the incision site or if this site has drainage with a foul odor
- There are signs of dehydration such as fewer wet diapers each day, the absence of tears when crying, or a fontanel (soft spot on the head) that appears sunken
- Vomiting occurs with more than three consecutive feedings or lasts longer than 48 hours after discharge
What is the long-term prognosis for pyloric stenosis?
This problem is unlikely to reoccur. Babies who have undergone the surgery should have no long-term effects from it.