Pyloric stenosis (also called infantile hypertrophic pyloric stenosis) is a narrowing of the pylorus - the passage leading from the stomach to the small intestine. When a baby has pyloric stenosis, the muscles in the pylorus have become too thick to allow milk to pass through it. This usually happens in the first 6 weeks after birth.
Experts do not know exactly what causes the thickening and enlargement of the muscles in the pylorus.
Pyloric stenosis affects far more boys than girls and tends to run in families.
If you think your child has pyloric stenosis, go to your doctor or after-hours medical centre straightaway. Do not delay as young babies who are not able to feed normally can become more ill very quickly.
Your doctor will ask about your baby's symptoms, including:
Your doctor may try to feel a mass or lump (which is the thickened pylorus) in your baby's stomach.
Your baby might need some investigations or tests.
An ultrasound may show the thickened pyloric muscle.
A doctor may give your child a small feed. This is to help your baby relax enough to allow the doctor to feel the lump in your child's tummy.
This is a special x-ray. Only a very small number of babies need it. A doctor or nurse will give your baby a small amount of chalky liquid (barium). Your baby will then have an x-ray of their abdomen, which will show the passage of the barium through the gut. Any blockage or narrowing will show on the x-ray.
In most cases, your baby will need a blood test.
The treatment for pyloric stenosis is an operation called a pyloromyotomy.
A team that usually includes a surgeon and an anaesthetist will do this operation using one of 3 techniques:
In all the operations, the surgeon cuts through and spreads the thickened and enlarged muscles of the pylorus, which relieves the blockage (obstruction).
Ask you doctor or nurse about when and what your baby can drink before the operation.
Your baby will need an intravenous drip [1] before the operation. Babies with pyloric stenosis usually have abnormal levels of several important substances in their blood. These levels must return to normal before the operation. This usually takes several hours and can even take a day or two.
Your baby's surgical team will explain what will happen during the operation, and any other treatment needed. You will have the opportunity to ask questions.
Your baby may need medicine to help with pain after the operation. This may be through an intravenous drip [1].
For the first few hours, your baby will continue to have fluids through the drip. This will give the stomach time to start healing. Your baby will be able to start feeding after about 12 hours. You will have to start with small amounts.
Your baby may still vomit some of the feed, but this won't be forceful or projectile vomiting as before. The vomits or spills will decrease over several days. You will be able to take your baby home once they are feeding normally.
Your baby may still be sore for a day or two once you go home. Your doctor will suggest medicines to help with pain after you leave the hospital.
Handle your baby normally.
Usually, you can bath your baby any time after the surgery. Check this with your surgeon.
Keep an eye on the wound. Take your baby to your doctor straightaway if you notice any signs of infection:
There is some risk with any surgery - bleeding during and after the surgery and a small risk with having an anaesthetic. There is a small chance of damage to the delicate lining of the bowel, but the surgeon usually finds and fixes this during surgery. Pyloric stenosis can happen again, but this is rare.
Images used with permission of Mayo Foundation for Medical Education and Research, all rights reserved.
This page last reviewed 21 September 2020.
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[1] https://www.kidshealth.org.nz/drips-intravenous-fluids-or-iv
[2] https://www.kidshealth.org.nz/contact?from=http%3A%2F%2Fwww.kidshealth.org.nz%2Fprint%2F186%3Flanguage%3Dmi