Two weeks on, and I was the manic mother because of a lack of sleep due to consistent projectile vomit, a concern for Tom, and a worsening situation. This resulted in another visit to a GP and the night before the ultrasound an emergency visit as Tom was vomiting blood.
We were fortunate, the ultrasound resulted in immediate admittance to Calderdale Royal, stabilising Tom, transferring to Sheffield Children’s Hospital, and keyhole surgery for Pyloric Stenosis.
US is the modality of choice for the diagnosis of hypertrophic pyloric stenosis (HPS). The imaging features of the normal pylorus and the diagnostic findings in HPS are reviewed and illustrated in this pictorial essay. Common difficulties in performing the examination and tips to help overcome them will also be discussed.
Because of the sheer number of generally healthy appearing children we see with a complaint of vomiting, it is often difficult to weed out the few that may be in the early stages of a critical illness. Bedside ultrasound can aid in early detection in two cases in particular: pyloric stenosis and intussusception. This post will address bedside ultrasound for pyloric stenosis.
Once associated with a high mortality when
first described in the early 18th century, surgery
for infantile hypertrophic pyloric stenosis today
is commonplace and all infants are expected
to make an uneventful recovery
Watching your child continually vomit is an emotional experience. It was embarrassing to see friends and family covered in milk after they volunteered to feed him. Rowan’s constant spitting up was messy, scary, and above all, not normal.
In my fog of mom of a newborn sleeplessness, I scoured the Internet looking for answers. Page after page offered tips for treating GERD and some even suggested other diagnoses.
One of which, pyloric stenosis, stuck out.
Although as abnormalities go, pyloric stenosis is not that rare, no one really knows why some babies get it and most don’t. First-born male infants are more likely to have it, but then again, more babies are first-born males!
The diagnosis, historically, is one made clinically; however, today, Ultrasound allows us to diagnosis pyloric stenosis earlier; often before the classic findings are apparent.
It usually starts after 3 weeks of age, but can begin anywhere up to 5 months. It is most common in firstborns, especially firstborn boys.
Infants with pyloric stenosis have a hard time keeping anything down after feedings―usually starting between 2 and 8 weeks of age.
The baby may vomit forcefully, ejecting breast milk or formula up to several feet away (projectile vomiting). Vomiting might be mild at first and gradually become more severe as the pylorus opening narrows. The vomit may sometimes contain blood.
The exact cause of the thickening is unknown. Genes may play a role, since children of parents who had pyloric stenosis are more likely to have this condition. Other risk factors include certain antibiotics, too much acid in the first part of the small intestine (duodenum), and certain diseases a baby is born with, such as diabetes.
Pyloric stenosis occurs most often in infants younger than 6 months. It is more common in boys than in girls.
Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis (IHPS), is an uncommon condition in infants characterized by abnormal thickening of the pylorus muscles in the stomach leading to gastric outlet obstruction. Clinically infants are well at birth. Then, at 3 to 6 weeks of age, the infants present with "projectile" vomiting which can lead to dehydration and weight loss.