Pyloric stenosis is when the passage between the stomach and small bowel (pylorus) becomes narrower. The passage is made up of muscle, which seems to become thicker than usual, closing up the inside of the passage. This stops milk or food passing into the bowel to be digested.
What are the symptoms of pyloric stenosis?
Pyloric stenosis is commonly seen in the first born male child of the family. In most cases, a baby with pyloric stenosis is well until the age of 3-4 weeks following which the child will begin bringing up small amounts of milk after feeding. Over a few days this will become worse until the baby can no longer keep any milk down. This vomiting may become so forceful that the milk may be projected for several feet out of the baby’s mouth. This is called projectile vomiting.
As the milk is lying in the acid in the stomach, it can curdle and become yellow in colour. This also reduces the amount of faeces (stool) passed, as little or no food is reaching the bowel.
If the condition is not treated, the baby will become dehydrated and not gain weight. Signs of dehydration include lethargy, reduced urine output and the soft spot (fontanel) on the top of the head may be sunken.
What causes pyloric stenosis and how common is it?
Pyloric stenosis is a fairly common reason for babies needing an operation and usually develops around four to six weeks after birth. We do not know exactly why pyloric stenosis develops, but it tends to affect more boys than girls, and seems to run in families too.
How is pyloric stenosis diagnosed?
The thickened pyloric muscle can be felt, especially during feeding, as a small, hard lump on the right side of the baby’s stomach. The muscles around the stomach can sometimes be seen straining, moving from left to right as they try to push milk through the pylorus.
Sometimes the doctors may want to confirm the diagnosis using tests and scans. These can include an ultrasound scan or even a contrast swallow and x-ray examination.
How is pyloric stenosis treated?
Pyloric stenosis is usually treated in an operation under general anaesthetic, lasting about 30 minutes. The operation is called a pyloromyotomy. Most are carried out using keyhole surgery (laparoscopically) but occasionally open surgery is suggested.
The effects of pyloric stenosis, like dehydration due to the vomiting, can become serious quite quickly in children, and so there are no alternatives to the operation.
What happens before the operation?
If your child is dehydrated, he or she will need a ‘drip’ of fluids for a while before the operation. This will make sure that your child’s blood contains the right balance of salts and minerals, and treats the dehydration. Your child will have the operation once his or her blood test results are normal.
They will also need a nasogastric tube, which is passed up the nose, down the food-pipe and into the stomach. This will drain off the stomach contents before the operation.
What does the operation involve?
The surgeon will cut through some of the thickened muscle, which widens the passage so that milk and food can pass into the bowel to be digested. If the operation was carried out using keyhole surgery, your child will have three small incisions in the abdomen, which will be closed with dissolvable stitches and skin glue. If your child has had open surgery, there will be a larger incision by the belly button, closed with dissolvable stitches,
What happens afterwards?
Your child will come back to the ward to recover. He or she will have been given pain relief during and after the operation. For the first few hours, your child will continue to have fluids through the drip so that the stomach and bowel can start to heal. After twelve hours or so, we will start to feed your child, starting with small amounts, and increasing the amount as he or she tolerates it. Your child may still have some vomiting but this will improve as the digestive system recovers from the operation. Your child will be able to go home once he or she is feeding well.
What is the outlook for children with pyloric stenosis?
Most pyloric stenosis operations are successful, with the immediate effect of reducing or stopping completely any vomiting after feeds.
