Hypertrophic Pyloric Stenosis is a congenital condition and a common digestive system disorder in infants. It occurs due to excessive development and thickening of the muscles at the exit part of the stomach, called the pylorus. The thickened muscles narrow the passage between the stomach and the duodenum, slowing down or even stopping the transfer of food (typically breast milk) from the stomach to the intestines. As a result, babies vomit forcefully within a minute or two after feeding. The condition occurs in approximately 1 in every 500 to 1,000 births. It is about four times more common in boys than in girls, and there is also a genetic predisposition.

Symptoms

Symptoms typically appear a few weeks after birth (on average between 4 to 8 weeks). The most common symptom is forceful, projectile vomiting of curdled milk shortly after feeding, without bile (i.e., the vomit is not green). Since the milk is expelled before it reaches the intestines, the baby remains hungry and cries frequently. A visible bulge may appear in the upper abdomen. If recurrent vomiting is not addressed, the baby may develop dehydration and malnutrition. The baby becomes lethargic, feeds less, and tends to sleep more. This creates a vicious cycle and, if not treated promptly, can become life-threatening. Therefore, if your baby between 4 and 8 weeks of age (sometimes symptoms can appear slightly earlier or later) vomits forcefully after each feeding, it is crucial to consult a pediatric surgeon immediately.

In babies admitted to the hospital with these symptoms, a medical history is taken and a physical examination is performed, followed by blood tests and ultrasound imaging. The diagnosis of pyloric stenosis is made based on the clinical suspicion and confirmed via ultrasound. An increase in the length and thickness of the pyloric muscle is diagnostic.

Treatment

Surgery is the only treatment option. After evaluating the baby’s blood work and providing necessary fluid therapy, the baby is taken to surgery. The procedure can be performed using either open or laparoscopic (minimally invasive) methods. Pyloric stenosis is one of the rare diseases in pediatric surgery where the outcomes of open and laparoscopic surgery are nearly identical. Therefore, the decision for open or laparoscopic surgery should be made individually for each child, considering all clinical findings and the family’s preferences.

During surgery, the surgeon makes an incision in the thickened pyloric muscle to open the passage between the stomach and the duodenum. Rare complications that may occur during or after surgery include bleeding, perforation of the stomach or duodenum, or recurrence of the condition.

Congenital hypertrophic pyloric stenosis can be successfully treated with early diagnosis and surgical intervention. Timely surgery and appropriate postoperative care enable the baby to recover healthily and return to normal feeding routines

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