How Is Pyloric Stenosis Diagnosed?
The doctor will ask detailed questions about the baby's feeding and vomiting patterns,
including what the vomit looks like. The baby will be examined, and any weight loss
or failure to maintain growth since birth will be noted.
The doctor will check for a lump in the abdomen, which usually is firm and movable and feels like an olive. If the doctor feels this lump,
it's a strong indication that a baby has pyloric stenosis.
When pyloric stenosis seems likely, an abdominal
ultrasound usually is done. The enlarged, thickened pylorus can be seen on ultrasound
images. The doctor may ask that the baby not be fed for several hours before an ultrasound.
Sometimes a barium swallow is done instead of an ultrasound. Babies swallow a small
amount of a chalky liquid (barium), and then special X-rays are taken to view the
pyloric area of the stomach to see if there is any narrowing or blockage.
The doctor also might order blood tests to check levels of electrolytes (minerals
that help keep fluids balanced and vital organs working properly). An electrolyte
imbalance often happens due to the ongoing vomiting of stomach acid and dehydration,
and needs to be corrected.
How Is Pyloric Stenosis Treated?
When an infant is diagnosed with pyloric stenosis, either by ultrasound or barium
swallow, the baby will be admitted to the hospital and prepared for surgery. Any dehydration
or electrolyte problems in the blood will be corrected with intravenous (IV) fluids,
usually within 24 hours.
A surgical procedure called pyloromyotomy, which involves cutting
through the thickened muscles of the pylorus, will relieve the blockage. The pylorus
is examined through a very small incision, and the muscles that are overgrown and
thickened are spread and relaxed.
The surgery can also be done through laparoscopy. This is a technique
that uses a tiny scope placed in an incision in the belly button, allowing the doctor
to see the area of the pylorus. Using other small instruments placed in nearby incisions,
the doctor can complete the surgery.
Most babies return to normal feedings fairly quickly, usually 3 to 4 hours after
the surgery. Because of swelling at the surgery site, a baby may still vomit small
amounts for a day or so. If there are no complications, most babies who have had pyloromyotomy
can return to a normal feeding schedule and go home within 24 to 48 hours of the surgery.
If you're breastfeeding, you might worry about continuing while your baby is hospitalized.
The hospital staff should be able to provide a breast pump and help you use it so
that you can continue to express milk until your baby can feed regularly.
After a successful pyloromyotomy, your baby won't need to follow any special feeding
schedules. Your doctor will probably want to examine your child at a follow-up appointment
to make sure the surgical site is healing properly and that your baby is feeding well
and maintaining or gaining weight.
Pyloric stenosis should not happen again after a pyloromyotomy. If your baby still
has symptoms weeks after the surgery, there might be another medical problem, such
as gastritis or GER, so let your doctor know right away.
When Should I Call the Doctor?
Pyloric stenosis is an urgent condition that needs immediate treatment. Call your
doctor if your baby:
- has lasting or projectile vomiting after feeding
- is losing weight or not gaining weight as expected
- is less active than usual or is very sleepy
- has few or no stools (poops) over a period of 1 or 2 days
- show signs of dehydration, such as more than 4 to 6 hours between wet diapers,
a sunken "soft spot" on the head, or sunken eyes
Date reviewed: March 2017