How to treat babies with forceful vomiting (pyloric stenosis)

How to treat babies with forceful vomiting (pyloric stenosis)

By Angela M. Hanna, MD
Pediatric Surgeon

Pyloric Stenosis (or infantile hypertrophic pyloric stenosis) is a condition characterized by forceful vomiting in an infant due to hypertrophy of the pylorus muscle leading to gastric outlet obstruction. This means the muscle where the stomach empties into the small intestine becomes too thick and prevents emptying. As a result, after eating, the baby vomits. The reason for this happening is not known but is likely caused by many things and family history can play a role. Pyloric stenosis is rare, occurring in about 3 of  every 1,000 live births, and most often occurs between the ages of 3-6 weeks, is more common in males, and 1/3 of the time occurs in a first-born child.
 
Vomit from pyloric stenosis usually consists of just milk or formula. Any vomit with color should raise suspicion for other diagnoses. Parents report vomiting from pyloric stenosis as forceful and projectile. Infants are often hungry after vomiting, wanting to continue eating, however eating usually continues the cycle of vomiting.
 
How to treat pyloric stenosis
 
To determine the cause of vomiting, your baby’s doctor will do a physical exam where a palpable mass in the upper abdomen, often described as an “olive,” can be found. Next, an ultrasound may be completed to see how thick the pyloric channel is.
 
Infants with pyloric stenosis can have an imbalance in electrolytes from vomiting, along with other low levels including potassium and chloride. So, the first step of treatment for pyloric stenosis is IV fluids to correct any imbalances prior to surgery. Surgery is the definitive treatment for pyloric stenosis.
 
One of the most common questions from parents is whether the baby can eat before surgery. Eating may cause the electrolytes to be abnormal, which would slow down the timing to be able to have the surgery. Therefore, it is best not to let the baby eat until deemed appropriate after surgery.
 
Surgery for pyloric stenosis
 
The surgery to fix pyloric stenosis is a “pyloromyotomy”, which means cutting the thickened muscle to split it apart so that food can pass through the channel. This operation can be done with an open incision or laparoscopically, with multiple tiny incisions and a camera. After surgery, the baby can usually start eating within a few hours. Vomiting after surgery for the first several feeds is common but something that is overcome quickly and usually ends before discharge from the hospital.
 
Babies with pyloric stenosis do great with treatment and continue to live normal, healthy lives, with no persistent or residual effects from pyloric stenosis.
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