What's the diagnosis? By Dr. Angela Ugorets
Wed, 08/12/2020 - 12:10am
Editor:
A 12 day old boy presents with vomiting every feed for 3 days. He has lost 4% of his body weight since birth. An ultrasound is shown below. What's the diagnosis? Scroll down for answer.
Answer: pyloric stenosis
History
- projectile, non-bilious vomiting after feeds
- patient will be hungry after feeds ("hunger vomiter")
- may have decreased urine output (dehydration), weight loss suggesting this is not just reflux / overfeeding
- commonly in first born males (4 times more common in males), typically presents between 3-5 weeks, should suspect in any infant with these symptoms
Exam
- classically can palpate "olive-like" mass in abdomen, however is often not appreciated
Diagnosis
- Ultrasound - pylorous length over 15mm and thickness greater than 3mm are diagnositc
Management
- pediatric surgery consult for pylorotomy which is definitive treatment
- evaluate with chemistry, patients are at risk for hypochloremic metabolic alkalosis from gastric acid loss, treat with IV fluids
References:
Olivé, Anthony P, and Erin E Endom . “Infantile Hypertrophic Pyloric Stenosis.” UpToDate, 22 Jan. 2020. https://www.uptodate.com/contents/infantile-hypertrophic-pyloric-stenosis?search=pyloric%20stensosi&source=search_result&selectedTitle=1~91&usage_type=default&display_rank=1