Disease Description (Causes and Symptoms)
- Definition: Infantile hypertrophic pyloric stenosis (IHPS) is a congenital digestive tract disorder in which the muscles of the pylorus (the connection between the stomach and duodenum) in a newborn become abnormally thick, narrowing the pylorus and obstructing gastric emptying.
- Causes/Pathophysiology:
- The cause is not fully understood, but associations have been reported with genetic predisposition (family history), ethnic differences (more common in Western populations), sex (male predominance, approximately 4:1), firstborn status, and formula feeding.
- Circular hypertrophy of the pylorus narrows the gastric outlet and increases gastric pressure, causing repeated projectile (non-bilious) vomiting.
- Prolonged vomiting can lead to dehydration and electrolyte abnormalities, mainly hypochloremia, hypokalemia, and metabolic alkalosis.
- Main symptoms:
- Projectile vomiting (non-bilious) beginning between 2–8 weeks of age and worsening immediately after feeding
- Weight loss or poor weight gain, malnutrition
- Signs of dehydration (dry lips, reduced tears when crying, decreased urine output)
- Strong gastric peristalsis (peristaltic waves visible in the abdomen before or after vomiting)
- A palpable “olive-shaped” pyloric mass in the upper right abdomen (not always present)
Treatment Methods
- Emergency and preoperative management:
- First, correct dehydration and electrolyte abnormalities, especially hypochloremia, hypokalemia, and metabolic alkalosis, with intravenous fluids. A stabilization period of approximately 12–24 hours is usually required.
- Standard treatment:
- Surgical treatment is the standard: Ramstedt pyloromyotomy (open or laparoscopic pyloromyotomy)—a procedure that opens the pylorus by making an incision in the pyloric muscle and is almost curative.
- Laparoscopic surgery has been increasingly used in recent years; it involves smaller incisions and faster recovery.
- Medication treatment:
- Conservative and medication treatment is not definitive and is therefore not recommended as standard treatment. (In exceptional cases, conservative treatment such as correction of electrolytes before surgery is performed.)
- Postoperative and daily care:
- Small amounts of feeding (breast milk or formula) are gradually resumed within a few days after surgery. Vomiting during the first few feedings is common.
- Care for the surgical wound and monitor for signs of infection (fever, redness of the wound).
- Precautions/risks of complications:
- If electrolytes and fluids are not adequately corrected before surgery, the risks of anesthesia and surgery increase.
- Rarely, delayed gastric emptying or wound complications may occur after surgery, and repeat surgery may be needed if the muscle incision is insufficient.
- With early diagnosis, appropriate electrolyte correction, and surgery, the prognosis is generally good.
Checklist Before an Outpatient Visit (Including Example Questions)
- Recommended items to bring:
- A list of currently used medications (including medications taken by the breastfeeding mother)
- Past medical history, surgical history, and family history (whether similar conditions have occurred)
- A record of recent weight changes (feeding amounts, number of vomiting episodes, and photos or records taken immediately after vomiting can be helpful)
- Recent test results, if available, such as blood tests or ultrasound
- Symptoms and observations to record for the outpatient visit:
- When vomiting began, its frequency, and its characteristics (projectile nature and whether bile is present)
- Changes in feeding amount and weight
- Urine output and bowel movements (frequency and color)
- Signs of dehydration (tears when crying, dry lips, etc.)
- Information to tell the doctor in advance:
- The baby’s current general condition (activity and willingness to feed)
- Whether there have recently been accompanying symptoms such as fever or difficulty breathing
- Example questions (questions the patient can write down before the outpatient visit):
- “What tests are needed to confirm the cause of the vomiting?”
- “Are there any tests I need to prepare for at the hospital or any fasting instructions?”
Examples of General Questions to Ask the Doctor
- What are the expected side effects of this medication (or treatment)?
- What is the expected prognosis for the baby? How long will recovery take after surgery?
- Are there any particular lifestyle or feeding instructions to follow before or after surgery?
- How likely are complications to occur, and what symptoms should we watch for?
Examples of Condition-Specific Questions
- To what extent must electrolytes and fluids be stabilized before surgery can proceed? (For example, what are the target serum chloride, potassium, and pH ranges?)
- Which approach is more suitable for our child, open surgery or laparoscopic surgery? (Taking into account the child’s weight, electrolyte status, and the surgeon’s experience)