Pyloric Stenosis Goals of Treatment Pyloric stenosis is not a surgical emergency, but proper diagnosis and correction of electrolyte abnormalities are important for rapid recovery of the infant CLINICAL PEARLS AND PITFALLS Pyloric stenosis leads to nonbilious emesis only Pyloric stenosis may present with hematemesis Severe metabolic alkalosis can lead to apnea Very early in the course of pyloric stenosis, ultrasound diagnosis based on measurements may be falsely reassuring; repeat US should be performed if symptoms persist Current Evidence Pyloric stenosis refers to an idiopathic hypertrophy of the pyloric muscle and occurs in in 250 births There is a male:female ratio of 4:1, and first born males are at higher risk A familial incidence has been shown, particularly if the mother had hypertrophic pyloric stenosis as an infant The age of onset is usually to weeks Rarely, the onset may be late in the second month of life The cause of the muscle hypertrophy is unknown, but the symptoms, diagnosis, and therapy are well defined Clinical Considerations Initial Assessment Characteristically, the infant does well, without vomiting, for the first few weeks of life and then starts vomiting, either at the end of feedings or within 30 minutes The infant is hungry and will eat immediately after vomiting The vomiting becomes more prominent and eventually becomes forceful, projectile emesis The vomitus is always nonbilious With protracted emesis, hematemesis can occur Infants with pyloric stenosis may also become jaundiced with the onset of the other symptoms The hyperbilirubinemia usually improves or abates postoperatively for reasons that are unknown Early in the course, infants may appear perfectly active and well hydrated In infants with protracted symptoms, moderate to severe dehydration may exist The abdomen is soft and nondistended and if the infant is relaxed, an “olive” mass may be palpable in the midepigastrium Sugar water can be used to help relax the