Pyloric Stenosis - Children's Hospital Boston

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My Child Has:

Pyloric Stenosis

Programs that treat this condition

Newborn Medicine, Community

What is pyloric stenosis?

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Pyloric stenosis is a common surgical problem that occurs in early infancy.

Pyloric stenosis causes vomiting as it's primary symptom. The vomiting usually happens in infants at 2-3 weeks of age, but can happen as late as 6 weeks of age. The vomiting is usually forceful and projectile -- it can be so forceful that it can be ejected from 1-4 feet from the child.

The vomit consists of clear fluid or curdled milk. The infants are healthy and vigorous, but develop episodes of spitting up and vomiting that progressively worsen. The vomiting occurs within 30-60 minutes of feeding. Commonly, after the infant vomits, he is then very eager to eat again.

How does a child get Pyloric Stenosis?

Pyloric stenosis occurs when the muscle surrounding the pyloric sphincter at the outlet to the stomach becomes thickened. (Fig. 1) This thickening can block the pyloric channel preventing the passage of feedings from the stomach into the small intestine. Vigorous contractions of the stomach wall attempt to force the feedings through the obstruction, but as it becomes tighter, these contractions result instead in the projectile vomiting.
Pyloric stenosis is more common in males than females and it occurs in up to 1% of otherwise healthy infants.

How do I know if my child has Pyloric Stenosis?

Many infants appear well with pyloric stenosis. The classic symptom is vomiting. However, with persistent vomiting the infants loose weight and may appear yellow or jaundiced and become dehydrated and lethargic.
Your infant's pediatrician and/or surgeon may be able to diagnose pyloric stenosis based on the history and physical exam. The abnormality in the pyloris may be felt by your pediatrician or surgeon. Often a radiology study is obtained in the hospital which is helpful in determining if your infant has pyloric stenosis. These radiology studies can include an ultrasound or an upper gastrointestinal series (UGI).

Is Pyloric Stenosis Dangerous?

Pyloric stenosis is a serious condition that can cause severe dehydration, weakness and weight loss if not diagnosed and treated effectively.

How is Pyloric Stenosis Treated?

Once the diagnosis has been made, the recommended treatment for pyloric stenosis is surgery. Your infant should be admitted to a hospital where skilled pediatric surgeons and other professionals can manage your infant's care. Prior to surgery your infant will have an intravenous played to replenish the nourishing fluids that your infant was not able to tolerate by mouth. The infant will also have blood work done to make sure that the dehydration is corrected and that it is safe to proceed with anesthesia and surgery. A small tube may be placed through the infant's nose into the stomach to help prevent persistent vomiting. Your child may receive antibiotics during the hospital course to prevent the possibility of any infection. You will meet with a pediatric surgeon and anesthesiologist to discuss the surgery and anesthesia prior to the operation.

What happens after the surgery?

After the surgery your infant will be monitored closely. Approximately 6 hours after the surgery they will be able to resume feedings. This may include taking small amount of formula from a bottle or breast feeding with mom. The nurses and surgeons will monitor the exact amounts of fluid that the infant has taken, and they will also observe for vomiting. It is common after the surgery that the infant may still have some intermittent episodes of vomiting. This should resolve within a few days. The nurses will also monitor for normal urine and bowel movements. Once the infant is tolerating a normal diet and appears well, preparations for discharge will be made. The infant should be weighed prior to leaving the hospital.

What do I need to do or look for once I am at home?

Make a follow-up appointment with the pediatric surgeon for approximately 2 weeks after discharge, as well as with your pediatrician within 1 week from discharge.
Remember that a small amount of intermittent vomiting with feedings is expected after surgery. However, it should not occur with every feed, and it should get better each day. If the infant is still having persistent vomiting with every feed, call your pediatrician, pediatric surgeon or the pediatric nurse practitioner.
Keep the incision clean and dry, no tub bathing until you follow-up with the pediatric surgeon or nurse practitioners.
Symptoms that you should call your pediatrician or pediatric surgeon for include:

Any questions or concerns.
If the infant is lethargic or feeding poorly.
Persistent vomiting with every feed.
Fever greater than 100.
Infected wound with pus, odor or redness at incision site.
Decreased numbers of wet diapers with urine. Need approximately 6 wet diapers per day.
Decreased numbers of diapers with stool. Breast fed infants can have approximately 1 stool with every other breast feed. Formula fed infants should have a stool at least every other day.



	The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional.

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