CONGENITAL HYPERTROPHIC PYLORIC STENOSIS

 



It is hypertrophy of musculature of pyloric antrum, especially the circular muscle fibres, causing primary failure of pylorus to relax. It is common in first born males and incidence is 4 in 1000 births. It is seen between the 3rd and 6th weeks of age of an infant (the time taken by the hypertrophied muscle to cause complete obstruction).

 

Clinical Features :

1.Vomiting—forcible, projectile and non-bilious.

2.Visible gastric peristalsis .

3.Palpable lump of hypertrophied pylorus which is better felt from left side, as a mobile, smooth, firm mass, with all borders well made out, moves with respiration, with impaired resonance on percussion.

4.Constipation.

5.Dehydration and loss of weight.

6. Electrolyte imbalance—hypokalaemic metabolic alkalosis.

7. Anorexia

 

Diagnosis is established by:

1. Clinical examination.

2. U/S abdomen (very useful)—i) Doughnut sign.

 ii) Pyloric muscle 4 mm or more in thickness.

 iii) Length of pyloric canal > 1.8 cm.

3. Barium meal shows obstruction.

 

Differential Diagnosis:

1. Duodenal atresia (Bilious vomiting is present).

2. High intestinal obstruction (e.g. volvulus neonatorum).


Treatment :

1. Correction of dehydration and electrolyte imbalance.

2. Surgery: Ramstedts operation—After laparotomy, hypertrophied muscle is cut along the whole length adequately until the mucosa bulges out. Mucosa should not be opened

(pyloromyotomy). If mucosa is injured, it should be sutured horizontally using interrupted vicryl or silk sutures. 

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