Digestion of food occurs at several parts of the gut. The stomach
acts as a reservoir, churning the food and mixing it with the stomach
acid to help sterilise the food by killing any bugs swallowed, but also
breaking down the food with the acid. The food is kept within the
stomach by a muscle, which shuts the narrow stomach exit, the so-called
pylorus. This muscle relaxes, the stomach squeezes and food is squirted
into the intestines.
In young babies this muscle can enlarge so keeping the stomach exit,
pylorus, permanently shut. When this happens, the pylorus muscle
relaxes, but because it is enlarged the exit remains shut. However, the
stomach knows that the pylorus muscle has relaxed so contracts, but now
food can only pass back up the gullet causing vomiting.
This narrowing, pyloric stenosis, occurs only in young babies,
commonly around 6 weeks of life, but it can occur shortly after birth up
to 12 weeks of age. After that age it is much less common. It is not
known why some babies develop this enlarged muscle, but it is more
common in first born male infants and also if one of the parents had the
same problem as a baby.
The muscle around the pylorus gets bigger slowly. Initially the baby
feeds well and keeps his food down. Then there are occasional vomits,
which slowly become more frequent to the point when the babe may be
vomiting most if not all of the feeds. The classical description of this
vomiting is projectile vomiting, that is a fountain of milk comes out
through the mouth and may project some 2 or 3 feet. The baby becomes
irritable because of hunger and may become dehydrated if little fluid is
kept down. The baby also loses a lot of stomach acid with the vomiting.
In hospital various tests may be done. Blood tests will be taken to
see whether the baby is dry or has lost acid and salt. A baby is given a
test feed. This is when the baby is given a feed that makes the pylorus
muscle contract. Doctors can sometimes feel this as a hard lump in the
baby's tummy. If there is still doubt, then either an ultrasound or a
barium meal is performed. An ultrasound can tell whether the pylorus
muscle is enlarged, a barium meal is when the baby is given barium,
which shows up on x-ray, to drink. The barium is then followed into the
stomach and then into the pylorus which will be very narrow.
When the diagnosis is made an operation is necessary. However, this
is not an emergency operation. First the baby must have any losses of
water, salt and acid corrected. If this doesn't happen then there are
increased chances of complications occurring after operation. Once this
has happened then the Ramstedt's operation is undertaken. There is a
small cut in the skin of the tummy and then the enlarged pylorus muscle
is cut. Occasionally the gut itself is cut by accident, but normally the
baby can feed pretty well immediately after the operation, as only the
muscle is cut and not the gut, which is still intact. Discharge from
hospital is usually 2 or 3 days after operation.