Pyloric stenosis

Pediatrics

Pyloric stenosis is idiopathic hypertrophy of the pylorus muscle, leading to gastric outlet obstruction. It is more common in males than in females and usually presents between 3 and 6 weeks of age with gradual onset of non-bilious projectile vomiting. Occasionally the hypertrophied pylorus muscle can be palpated as an olive-sized mass in the upper right quadrant.

Abdominal radiographs in pyloric stenosis may show a dilated, gas-filled stomach. Ultrasound is diagnostic; the pyloric channel is thickened and elongated with a length exceeding 12 mm and muscle thickness greater than 3 mm.

Pyloric stenosis. The pylorus is thickened and elongated measuring 18 mm in length and 6 mm in wall thickness. The hypoechoic structure superior to the pylorus/gastric antrum is the gallbladder. The stomach is to the upper left of the pylorus and contains echogenic material.

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Emergent management consists of bowel rest, volume resuscitation, and correction of any electrolyte abnormalities. Definitive treatment is surgical pyloromyotomy

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