II. Epidemiology
- Ages 4-12 weeks old (mean 3 weeks)
III. Pathophysiology
- Hypertrophy of pylorus of Stomach causing a gastric outlet obstruction
IV. Risk factors
- Bottle Feeding
- Family History of Pyloric Stenosis (especially northern european)
- Male gender (4 times more common than in girls)
V. Symptoms: Vomiting
- Non-Bilious Vomiting
- Starts intermittently
- Progressively increases in frequency and severity
- Projectile Vomiting in up to 70% of cases
VI. Signs
- Typically, otherwise well appearing infant with benign Abdomen
- Palpable swelling ("olive") present in >60% of cases in past when delayed presentation was common
- In 2016 olive is rare due to early presentations
- Inferior to xiphoid process and inferior or deep to left liver edge
VII. Labs
- Basic metabolic panel
- Hypochloremic hypokalemic Metabolic Alkalosis
- Rarely seen due to early presentations in U.S.
- Hypochloremic hypokalemic Metabolic Alkalosis
VIII. Imaging: Ultrasound
- Technique
- Linear probe in subxiphoid location, horizontal probe
- Look for gastric rugae, smooth outer serosal surface, slightly thicker wall
- Trace the outer surface of the Stomach down to the pylorus and duodenum
- Duodenal wall is much thinner than pylorus
- Diagnosis
- Thickened and elongated pylorus
- Pylorus wall thickness >3 mm
- Pylorus length >15 mm (variable)
- No relaxation
- No fluid passage within channel
- May see very minimal flow (string sign)
- Thickened and elongated pylorus
IX. Complications
- Pediatric Dehydration
- Hypochloremic hypokalemic Metabolic Alkalosis
- Rarely seen due to early presentations in U.S.
X. Management
- Correct fluid and electrolyte abnormalities
- Surgery (pyloromyotomy)
XI. Resources
- Pyloric Stenosis Ultrasound
XII. References
- Bukata (2013) Pediatric Emergencies, EM Bootcamp, CEME
- Nazer (2013) Pediatric Hypertrophic Pyloric Stenosis, EMedicine
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| Definition (NCI) | Narrowing of the pyloric lumen caused either by hypertrophy of the surrounding muscles or tissue scarring due to a chronic peptic ulcer. |
| Definition (MSH) | Narrowing of the pyloric canal with varied etiology. A common form is due to muscle hypertrophy (PYLORIC STENOSIS, HYPERTROPHIC) seen in infants. |
| Concepts | Finding (T033) |
| MSH | D011707 |
| ICD10 | K31.1 |
| SnomedCT | 367403001 |
| English | Pyloric Stenosis, PYLORIC STENOSIS, pyloric stenosis (diagnosis), pyloric stenosis, Pyloric Stenosis [Disease/Finding], gastric outflow obstruction, pyloric stenoses, pyloric stenosi, gastric outlet obstruction, pyloric obstruction, Gastric Outlet Obstruction, Pylorus--Stenosis, Pyloric stenosis, PS - Pyloric stenosis, Pyloric stenosis (disorder), pylorus; stenosis, pylorus; stricture, stenosis; pylorus, stricture; pylorus, Stenosis, Pyloric, Pyloric stenosis NOS, Stenosis pyloric |
| Portuguese | ESTENOSE PILORICA, Estenose pilórica, Estenose pilórica NE, Estenose Pilórica |
| Spanish | ESTENOSIS PILORICA, Estenosis pilórica, Estenosis pilórica NEOM, estenosis pilórica (trastorno), estenosis pilórica, Estenosis Pilórica |
| German | PYLORUSSTENOSE, Pylorusstenose NNB, Pylorusstenose |
| Dutch | pylorusstenose, stenose pylorus, pylorusstenose NAO, pylorus; stenose, pylorus; strictuur, stenose; pylorus, strictuur; pylorus, Pylorusstenose, Stenose, pylorus- |
| Italian | Stenosi del piloro, Stenosi del piloro NAS, Stenosi pilorica |
| French | Sténose du pylore SAI, STENOSE DU PYLORE, Sténose pylorique, Sténose du pylore |
| Japanese | 幽門狭窄ＮＯＳ, ﾕｳﾓﾝｷｮｳｻｸNOS, ﾕｳﾓﾝｷｮｳｻｸ, 幽門狭窄, 幽門狭窄症 |
| Swedish | Pylorusförträngning |
| Czech | pylorus - stenóza, Pylorostenóza, Pylorostenóza NOS |
| Finnish | Mahanportin ahtauma |
| Russian | PILOROSTENOZ, ПИЛОРОСТЕНОЗ |
| Polish | Zwężenie odźwiernika |
| Hungarian | Pylorus stenosis k.m.n., Stenosis pylorikus, Pylorus stenosis |
| Norwegian | Pylorusstenose, Magemunnsforsnevring |
