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Pyloric Stenosis

There is no conclusive evidence for the origin of PS; however, both hereditary and environmental influences are believed to be contributory. Multiple factors, including both neural and hormonal, have been implicated but not substantiated in the development of PS. An association with B and O blood groups and maternal stress during the third trimester have also been suggested. Although now believed to be acquired, cases of PS diagnosed prenatally and in neonates have been reported.

Pyloric stenosis is the most common pediatric surgical disorder that causes emesis requiring surgery in the Western world. It occurs in approximately 3 per 100 live births in the United States. It is most commonly seen in whites of northern European descent, less in blacks, and is rarely found in patients of Oriental or Indian ancestry. Males are more often affected than females (4:1), with first-born males observed to be more frequently afflicted pyloric stenosis, piloric, stanosis

Pathology

The lesion involves hypertrophy of the circular muscle of the pylorus resulting in narrowing and obstruction of the pyloric channel by compression of longitudinal folds of mucosa. Grossly, the pylorus is enlarged, resembling a "tumor" approximating the size and shape of an olive (2 cm long, 1 cm diameter).

Clinical Presentation

Pyloric stenosis occurs in patients between 1 and 10 weeks of age. Classically, projectile vomiting occurs that is always nonbilious, but may have brown discoloration or a coffee ground appearance from associated gastritis,

Examination of the infant is preferably conducted in a warm environment with the baby quiet or sleeping. A general sense of hydration is assessed first with particular attention to the baby's level of consciousness

The infant is best examined from the right, with mild pressure applied with the first three fingers of the right hand directed in a cephalad direction. Careful examination will reveal an oblong, smooth, hard mass, 1 to 2

Treatment

Although medical treatment of PS has been employed, pyloromyotomy has been firmly established as the treatment of choice in this condition. However, this statement should not undermine the importance in medical management of patients with PS. Early assessment and treatment of fluid, electrolyte, and acid basePostoperative Issues

Although safe, curative, and performed virtually without operative mortality, pyloromyotomy is not without potential complication. Duodenal or gastric perforation, the most serious of complications, rarely occurs but, if unrecognized prior to wound closure, may have devastating or lethal consequences. The infant with an enteric

Pyloric stenosis, developing after repair of tracheoesophageal fistula, has been reported and has been observed in a number of our own patients. This observation has applicability to the postoperative TEF repair patient who develops vomiting. Pyloric stenosis in addition to GER should be considered in these patients.

Many surgeons advocate early, incremental feeding in the immediate postoperative period . Intermittent vomiting, persisting through the first postoperative week, is sometimes seen in patients with a