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Pyloric stenosis in children: Treatment, symptoms, advice and help

 

Introduction


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.


Symptoms


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.


Diagnosis


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.


Treatment


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.