This document discusses infantile hypertrophic pyloric stenosis (IHPS), a condition where the pyloric muscle of the stomach becomes thickened, preventing food from passing normally into the small intestine. The key points are: - IHPS is most common in firstborn males under 6 weeks of age and may be linked to erythromycin use as an infant. - Symptoms include projectile vomiting, dehydration, and weight loss. Diagnosis involves feeling an olive-sized lump in the stomach and confirming on ultrasound or blood tests. - Treatment involves rehydration followed by pyloromyotomy surgery to cut the thickened muscle and allow food to pass through. Complications

1. SILAH AYSHA K S

2. 
 Hypertrophy of musculature of pyloric antrum,
especially the circular muscle fibres
 Failure of pylorus to relax.
 Gastric outlet obstruction
 Duodenum is normal.
 Increased risk if newborn gets erythromycin or
azithromycin in first 14 days after birth.
INFANTILE HYPERTROPHIC
PYLORIC STENOSIS

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4. 
 It is postulated that abnormal innervation of the
muscular layer leads to failure of relaxation of the
pyloric muscle, increased synthesis of growth
factors, and subsequent hypertrophy, hyperplasia,
and obstruction.
 Erythromycin has a prokinetic effect on gastric
muscle contraction.
ETIOLOGY

5. 
 Common in first born males(4:1)
 Incidence: 4 in 1000 live births
 Familial link found.
 Seen between 3rd and 6th weeks of age , time taken by
the hypertrophied muscle to cause complete
obstruction
CLINICAL FEATURES

6. 
 Vomiting – forcible, projectile and non-bilious,
may occur after every feed or only after some feed.
 Despite stomach distension, affected infants seem to
have an insatiable appetite and may cry
inconsolably.
 Constipation
 Dehydration
 Loss of weight
SYMPTOMS

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8. 
 Visible gastric peristalsis
 Palpable lump of hypertrophied pylorus , better felt
from left side, as a mobile, smooth, firm, olive like
mass , with all borders made out, moves with
respiration, with impaired resonance on percussion.
 Electrolyte imbalance(hyponatremic, hypokalemic,
metabolic alkalosis with paradoxic aciduria)
SIGNS

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 VGP and mass is better seen and felt
 Vomiting is regurgitant
 Anorexia common
In premature infants,

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 Biochemical assessment(pH>7.45, Cl- 3mEq/L)
 X ray Abdomen
 USG- doughnut sign,
pylorus > 4 mm thickness,(normal<2mm)
pyloric canal > 14 mm,(normal<10mm)
cervix sign on long axis,
target sign on short axis.
INVESTIGATIONS

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 Barium meal, not usually done. If done, shows string
sign/railroad track sign/double track sign with pyloric
obstruction.

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14. 
 Gastroesophageal reflux (non projectile,no weight
loss)
 Viral gastroenteritis(not in <6wks old, diarrhea)
 Duodenal atresia (bilious vomiting)
 Adrenal crisis(hyperkalemic acidosis)
 High intestinal obstruction( eg: volvulus
neonatorum)
 Intracranial haemorrhage
DIFFERENTIAL
DIAGNOSIS

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 Correction of dehydration and electrolyte imbalance.
 Intravenous fluid therapy is begun with 0.45–0.9%
saline, in 5–10% dextrose, with the addition of
potassium chloride in concentrations of 30–
50mEq/L until the infant is rehydrated and the
serum bicarbonate concentration is less than
30mEq/dL, which implies that the alkalosis has been
corrected.
 Most infants can be rehydrated within 24 hours
TREATMENT

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 Surgery –
1. Ramstedt’s operation- After laparotomy,
hypertrophied muscle is cut out along the whole
length adequately until mucosa bulges out.
Muscosa not opened.
2. Laparoscopic pyloromyotomy
 Oral feeds reintroduced in 8-12 hrs, post-op vomiting
resolves in 24 hrs.

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18. 
 Postoperative pyrexia
 Gastroenteritis
 Electrolyte imbalance
COMPLICATIONS OF
SURGERY

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