What is Pyloric Stenosis?

It is a disease characterized by hypertrophy (excessive development) of the muscle we call the pylorus at the outlet of the stomach, causing stenosis in the pylorus. Since the exact cause is unknown, it is called Idiopathic Hypertrophic Pyloric Stenosis (IHPS).

This disease typically presents clinical findings in babies between the 2nd and 8th weeks, usually around 1 month of age. The disease is characterized by gushing, non-bilious vomiting and can lead to serious metabolic problems if not treated in a timely manner.

Is the disease common?

The disease is seen in 1 in 300-900 (average 500) live births. It is seen 2-5 times more frequently in male babies. Interestingly, it is even more likely to be seen in B and O blood groups.

Why Does Pyloric Stenosis Occur?

The exact cause of the disease is unknown. The fact that it is seen 4-15 times more frequently in babies with a family history of IHPS suggests that the disease may be familial, but a genetic factor has not been determined. On the other hand, although it is not certain, it is thought that the type of nutrition, seasonality and premature birth may have an effect.

Can Pyloric Stenosis Formation Be Prevented?

No preventive factor has been identified so far.

Why Is Pyloric Stenosis Important?

Since the stomach outlet is blocked, food cannot pass into the small intestine, so the baby vomits forcefully like a gush, and many problems develop. The most important of these problems is that the baby is dehydrated because it cannot feed. Since it cannot take in nutrients, it cannot meet its nutritional needs. In addition, some minerals found in the stomach fluid and important for the body are lost with vomiting. The baby's weight gain stops and after a while it starts to lose weight. It becomes quite weak in a short time.

What are the Clinical Findings of Pyloric Stenosis?

The most common finding is vomiting that includes food and stomach fluid in a gush manner. It is completely different from the light vomiting that babies vomit when they pass gas from their mouth. The baby is usually constantly hungry and very eager to feed and cries constantly. A large amount of breast milk or formula is squirted forward and thrown out of the stomach. It vomits from its mouth and nose, the vomit is non-bilious, contains formula and sometimes looks like coffee grounds. This vomiting occurs immediately after feeding and the baby cries constantly because it is not full. If left untreated, the baby becomes weak because of not being fed, loses fluid and electrolytes and may become unable to cry.

The onset of characteristic vomiting may be as early as 1 week, or as late as 5 months. Characteristic vomiting is vomiting that squirts after almost every feeding. Interestingly, despite all this vomiting, the baby has an appetite and is eager to eat. Weight gain stops and even begins to lose weight.

Over time, symptoms of increased alkalinity in the blood begin due to fluid loss and loss of stomach acid. Exhaustion, absent-mindedness, and drowsiness set in due to fluid loss, and even consciousness may become impaired.

Other findings are weight loss, dehydration, infrequent defecation, constipation, mild jaundice, increased heart rate and paleness.

When looked at carefully, contraction movements of the stomach (peristalsis) can be seen and agitation can be heard when listening.

Can Pyloric Stenosis Be Diagnosed in the Womb or Earlier?

It cannot be diagnosed because it does not show clinical findings.

How is Pyloric Stenosis Diagnosed?

In addition to a typical family history, a detailed and careful examination will reveal a hard, olive-sized mass in the middle of the abdomen. Some tests are requested to rule out other diseases that may be confused with pyloric stenosis.

Blood tests are important to determine the amount of minerals and fluids the baby has lost from the body. There may also be bleeding and anemia due to vomiting.

Abdominal ultrasound is very valuable in the diagnosis of pyloric stenosis. It is an imaging method that uses high-frequency sound waves. It is used to measure the thickness and length of the pyloric muscle. It does not contain radiation, so it is not harmful, but it is valuable when interpreted by experienced users.

 

Barium gastrointestinal X-ray is used to evaluate the esophagus, stomach, pyloric canal, and the first part of the small intestine. Barium sulfate is a dense white liquid that can be seen with radiological imaging. In this film, the liquid that reaches the stomach is seen to pass from the stomach to the first part of the small intestine through a narrow channel and late. However, this is not often needed.

 

Can Pyloric Stenosis Be Confused with Other Diseases?

Yes, it can be. If inexperienced people try to treat it, it can be confused with the following diseases in particular; Pyloric atresia and duplication, antral web, some diseases related to the metabolic and nervous systems (subdural hemorrhage, hydrocephalus, meningitis), some of the anomalies of gender development.

How is Pyloric Stenosis Treated?

Pyloric stenosis is treated in two stages. A tube extending from the nose to the stomach is inserted to relax the baby's stomach and prevent vomiting. The first stage is to complete the fluids and minerals lost by the baby by giving serum. When the losses are compensated and the blood values ​​​​are corrected, the baby is ready for surgery to open the narrowing in the pyloric canal. In the second stage, the thickened muscles in the lower part of the stomach are separated with surgery and the narrowing is relieved. This procedure allows nutrients from the stomach to pass into the small intestines. This surgery can be performed openly or laparoscopically.

Can Surgery Be Performed Laparoscopically?

Yes, it can be performed.

Does Laparoscopic (Closed) Surgery Have Advantages Over Open Surgery?

Yes, there are. The main advantages are;

• Less pain
• Less bleeding
• Less infection
• Less surgical scars or even no scars
• Shorter hospital stay
• Faster and easier recovery
• Earlier nutrition

How is Laparoscopic (Closed) Surgery Performed?

Carbon dioxide (CO2) gas is injected into the abdomen through the tiny holes opened in the abdomen to create a large area in the abdomen and the abdomen is inflated. New tubes are placed by making incisions on the skin in appropriate places, one 3 or 5 mm from the belly button and two 3 mm wide incisions on the sides. The planned surgery is performed by placing “long surgical instruments” through these newly added tubes.

However, it should not be forgotten that Laparoscopy can cause more serious complications when performed by inactive people.

What Will the Process Be Like After the Surgery?

Your baby is given painkillers during the surgery to ensure a comfortable period after the surgery. The medication dose is repeated every 8 hours after the surgery.

How is Post-Surgery Feeding Done?

Small amounts of feeding are started 6-8 hours after the surgery and full feeding is started within 24-48 hours and your baby is usually discharged on the 3rd day. It is recommended that the amount of feeding is not increased too quickly and not to exceed 90 milliliters in the first days. Your baby may vomit in the first days, but this usually passes completely after the first week.

It is important to keep the surgical incision clean after the surgery. He/she can take a bath after 3 days.

After discharge, if there is a fever over 380C, redness, swelling or foul-smelling discharge in the surgical area, restlessness, vomiting after 3 consecutive feedings or a decrease in urine volume, you should consult a doctor again.

What Kind of Complications Can Occur During the Surgery?

Since the patient will receive general anesthesia, there may be complications of anesthesia, and the Family Anesthesiologist will inform you about this.

As a surgery; Wound Infection, Recurrence due to inadequate surgery, Bleeding and Perforation (Rupture of the Pylorus) may be seen. For these reasons, if it is not performed by competent people, a second surgery may be required.

Will it recur when the treatment is successful, will it cause any problems in the long term?

If the surgery is performed properly, it will not recur, and will not cause any problems in the long term.

*** The information provided here, the content of the website, is arranged for the purpose of informing visitors, especially families. No information should be considered as advice by visitors and should not lead to any decision or action. The patient should definitely be examined by a pediatric surgeon on the subject, should consult with him and make a decision by consulting his/her personal knowledge.