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Pyloric
stenosis (sometimes called Infantile Hypertrophic Pyloric
Stenosis) is a relatively common condition, affecting one in
three hundred babies. Boys are affected more commonly than girls,
and children of individuals who had pyloric stenosis in infancy
are at slightly increased risk of having it themselves.
The hallmark of pyloric
stenosis is forceful vomiting (sometimes described as "projectile")
that occurs shortly after feeding, and consists of partially
digested formula or milk. Affected babies typically come to
the attention of a surgeon at four to six weeks of age, although
the vomiting may begin when the child is as young as two weeks.
Vomiting results when
the ring of muscle at the outlet of the stomach (the pylorus)
becomes enlarged (or "hypertrophied"). The abnormally enlarged
muscle blocks the passage of food to the small intestine,
leaving the contents of the stomach no where to go but up.
The diagnosis is made when the surgeon feels the enlarged
muscle in the baby's upper abdomen. Often, an ultrasound is
done to confirm the doctor's findings.
Because vomiting may
lead to dehydration and electrolyte disturbances, it is considered
a medical (if not a surgical) emergency. The most important
first step in treating an infant with pyloric stenosis is
to restore good hydration and to correct electrolyte abnormalities.
Once accomplished, surgery to correct the problem may safely
be performed.
What
should parents expect after surgery for pyloric stenosis?
The operation may be
done through a small incision in the umbilicus (belly button),
the right upper quadrant of the abdomen, or with a laparoscope.
These tiny incisions are injected with local anesthesia, and
the babies are usually completely comfortable after surgery.
The surgeon will usually start to feed the baby again about
8-12 hours after the procedure.
What if my
baby vomits again after the surgery?
It's almost routine for
babies to vomit in the first few days after surgery, probably
because the lining of the stomach has become irritated from
the vomiting experienced preoperatively. This usually resolves
on its own, and shouldn't be a cause for concern.
Can pyloric
stenosis recur? What should I watch for at home?
Pyloric stenosis almost never
recurs. Your baby is not at risk for any special problems-this
is something that happens to otherwise perfectly healthy babies.
The most common complication after surgery is a minor wound infection,
which your surgeon will check for at your postoperative visit.
What
causes pyloric stenosis?
Surprisingly for such a common
condition, we don't really know. (Research into this area
is ongoing.) We do know that it seems to have nothing to do with
what the baby ate, or what the mother or father did before or
during the pregnancy. (Translation:
it's not your fault, any more than the weather is.)
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