Pyloric stenosis is a narrowing of the pylorus, the outlet of the stomach, which prevents food from moving to the small intestine. It typically affects infants between 2-8 weeks of age and is caused by hypertrophy and hyperplasia of the pyloric muscles. Clinical features include projectile vomiting, hunger but inability to gain weight, and dehydration. Diagnosis is confirmed through physical exam finding an olive-sized mass in the epigastrium and testing like barium meal x-rays. Management involves initial IV fluids followed by pyloromyotomy surgery to cut the thickened pyloric muscle.

1. PYLORIC STENOSIS
Rahul Moothedan MSc(N)

2. DEFINITION
• Pyloric stenosis is defined as narrowing and
obstruction of the lower portion of the
stomach (pylorus) that prevents food from
moving from the stomach to the intestine.
• It is caused due to the hypertrophy and
hyperplasia of circular muscles of stomach.

5. INCIDDENCE AND ETIOLOGY
• It is often seen in infants between 2 -8 weeks
of age. It affects 1 out of every 500 – 1000 live
births.
• No particular causes has been identified,
though both genetic and environmental
factors are thought to be involved.

6. PATHOPHYSIOLOGY
Infant develops dehydration and hypochloremic alkalosis
Persistent vomiting and dilated stomach musculature
In an attempt to push down, vigorous peristalsis occurs
Stomach contents cannot flow easily through constricted pylorus
Narrowing of pylorus and then almost complete obstruction
A diffuse hypertrophy and hyperplasia of smooth muscles of pyloric sphincter

7. CLINICAL FEATURES
• Initial presentation is regurgitation and non-bilious
vomiting
• Projectile vomiting
• Infants feels hungry
• Weight loss or failure to gain weight, dehydration,
fewer bowel movements, reduced frequency and
amount of stool.

9. DIAGNOSTIC EVALUATION
• Physical examination reveals a firm, olive sized mass in
the epigastrium, to the right of the midline.
• In severely malnourished, epigastric distention may be
seen and peristaltic waves may be seen passing left to
right , during and after feeding.
• Barium meal x-ray studies
• Blood investigations is done for electrolyte imbalance. Ph
• Specific gravity.

11. MANAGEMENT
• It is done in two stages. Initially fluids are given IV.
• Pyloromyotomy or Fredet-ramsted surgery. Either an
open or laproscopic surgical approach.