When Your Child Has Infantile Hypertrophic Pyloric Stenosis

What are the symptoms of infantile hypertrophic pyloric stenosis?

A child with pyloric stenosis may have:

• Vomiting, often forceful (projectile vomiting).

• Hunger right after vomiting.

• Loss of weight or poor growth despite having a good appetite.

• Signs of dehydration such as less urine, very dark urine, dry mouth, and no tears when crying.

• A lot of stomach movements after feeding.

• Few or no bowel movements.

How is infantile hypertrophic pyloric stenosis diagnosed?

During a physical exam, the health care provider may be able to feel a lump of thickened muscle through the belly (abdominal) wall. Your child may need tests such as:

• Abdominal ultrasound. Sound waves are used to create an image of the inside of the abdomen and the pylorus.

• Upper GI (gastrointestinal) X-ray. The baby takes a liquid called contrast that lights up on an X-ray. An X-ray image is taken of the stomach and top of the small intestine, which shows the pylorus. Only a very small amount of contrast gets out of the stomach. This test may be done if the lump can't be felt or the ultrasound isn't clear.

How is infantile hypertrophic pyloric stenosis treated?

Pyloric stenosis is treated with a surgery called pyloromyotomy. The surgery may be done with several small incisions (laparoscopic surgery). Or it may be done with one larger incision (open surgery).

If your child is dehydrated, this must be treated before surgery can be done. Fluids are given through an IV (intravenous) line. These replace the fluids your child’s body has not been able to absorb from feeding. Blood tests may also be done to check for problems that dehydration may cause.

During surgery, the thickened muscle is cut. The stomach contents can then flow into the intestine. In most cases, your child can start eating again about 3 to 4 hours after surgery. Your child can go home about 24 hours after surgery.

Your baby will have follow-up visits with the pediatric surgeon. This is to make sure your baby is eating well and gaining weight, and that the surgical incisions are healing.

What are the long-term concerns?

After treatment, most children don’t have long-term problems. In the short term, your child may still have some vomiting or reflux. Reflux is a small amount of liquid coming up from the stomach into the mouth. This is normal for a short time after surgery. It should go away as your child heals. Even after surgery, there is a small chance the muscle around the pylorus will thicken again.

When to call the doctor after surgery

After surgery, call the health care provider if your child:

• Has vomiting that won’t stop or looks green.

• Cries and can’t be soothed. This can mean your child is in severe pain.

• Loses weight or has no weight gain.

• Has no bowel movement within 2 to 3 days after surgery.

• Shows signs of dehydration such as less urine, very dark urine, dry mouth, and no tears when crying.

• Shows low energy.

• Has a fever of  100.4ºF ( 38.0°C) or higher, or as advised by the provider.