Pyloric Stenosis – Diagnosis and Treatment

Diagnosis

Imaging Procedures

Health experts commonly use imaging scans to confirm pyloric muscle problems. Ultrasound is the most common test and can show if the muscle around the pylorus is thickened or causing a blockage.

During this exam, a small device gently moves over the baby’s abdomen. Images appear that help doctors see how the muscle looks and whether it is blocking the passage between the stomach and small intestine.

In some cases, an upper gastrointestinal (GI) series helps diagnose the issue. The baby swallows a special liquid, and X-ray pictures show how it moves through the stomach.

This reveals issues like delayed stomach emptying or problems with digestion. Sometimes, doctors also check for wavelike motions in the belly, called peristalsis, which happen when the stomach tries to push food through the narrowed opening.

Lab Work and Mineral Levels

To check for dehydration and mineral imbalances, doctors order blood work. These blood tests help spot problems like low sodium, potassium, or chloride levels, which can happen if the baby vomits a lot.

Lab results may also reveal metabolic alkalosis, a common sign when the body tries to balance lost acids due to ongoing vomiting.

Checking these values helps the medical team know if dehydration needs to be fixed before treatment for the pyloric muscle problem.

Managing Pyloric Stenosis

Therapy Choices

Surgery is the main way to handle pyloric stenosis. First, the patient receives fluids and essential minerals in a hospital setting, usually through a vein.

The care team restores the right balance of water and minerals before starting the operation, and this preparation often lasts between 24 and 48 hours.

The most common surgical approach is called pyloromyotomy. During this procedure, a surgeon carefully cuts the overgrown muscle of the pyloric valve.

Then, special tools gently pull the muscle apart, reaching down to the lining of the stomach.

This step relieves the blockage but keeps the stomach protected. The stomach lining pushes slightly into the new gap, but nothing from the stomach leaks out. This operation allows food to pass through normally again.

Laparoscopic pyloromyotomy is a popular choice. Surgeons make three small cuts in the belly. One opening holds a camera to guide the process, and the other two hold instruments for the operation.

Laparoscopic techniques usually lead to quicker healing and less pain after surgery. Sometimes, if this is not possible, a doctor performs an open operation using a single, larger cut.

After the procedure, medical staff closely monitor the patient, usually for at least 24 hours. Babies can often begin feeding again just 12 to 24 hours after surgery.

Care teams might suggest feeding when the baby shows interest or on a fixed schedule. Some vomiting can still happen for a short time after surgery.

Severe side effects, such as bleeding and infection, are rare, and most children recover well.

Rare Non-Surgical Choices

For babies who cannot safely have an operation, a medicine called atropine sulfate can sometimes be used. This drug can relax the muscles around the pylorus.

This method is less successful than surgery, may require a longer hospital stay, and is not the standard way to treat pyloric stenosis.

Table: Summary of Treatment Approaches

Treatment Type	Main Benefit	Possible Drawbacks
Pyloromyotomy surgery	Quick recovery, high success rate	Need for anesthesia, rare complications
Laparoscopic approach	Smaller cuts, shorter healing time	Not always possible
Anticholinergic medication	Useful if surgery is too risky	Lower success, longer stay

Getting Ready for Your Visit

Steps You Can Take

Parents can prepare by bringing a list of their baby’s symptoms, including any episodes of vomiting, especially if it has been forceful or “projectile.”

Note if the vomiting happens after each feeding or only sometimes, and write down the time and frequency of each episode.

Include details about feeding routines, such as whether your baby is breastfed or bottle-fed, and any changes you’ve noticed in appetite or wet diapers.

Keeping a feeding and symptom diary in a notebook or on your phone can make it easier to give accurate information to your healthcare provider.

Have your baby’s medical records, a list of current medications, and any recent weight measurements ready. This helps the team quickly get a full picture of your baby’s health.

Important Things to Discuss With the Doctor

Bringing questions to your appointment can help make sure you get the answers you need. Examples of questions include:

• What is causing my baby’s vomiting?
• Are certain tests needed for diagnosis? If so, how should we prepare?
• Will my child require surgery, and how soon?
• Are there any feeding rules or restrictions before or after treatment?
• What kind of follow-up care or appointments will be needed?

Feel free to ask your own questions about your baby’s symptoms, recovery, or future feeding plans.

What Your Healthcare Provider May Ask You

Doctors will ask you several questions to better understand your baby’s condition. They may want to know:

Question	Why It’s Important
When did the symptoms start?	Helps track the progress of illness.
Is vomiting continuous or only after feeding?	Distinguishes types of digestive issues.
Is the vomiting forceful (projectile)?	Can indicate pyloric stenosis.
What color is the vomit?	May suggest different causes.
How many wet diapers per day?	Checks hydration.
Last recorded weight?	Monitors growth or weight loss.
Is blood seen in stool?	Alerts to possible complications.
Does your child act hungry after vomiting?	Gives clues about feeding tolerance.