Pediatrics, Pyloric Stenosis Follow-up

  • Author: Jagvir Singh, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Jun 22, 2010
 

Further Inpatient Care

The infant with pyloric stenosis should continue to receive intravenous fluid until feeding is resumed. Feeding can be initiated 4-8 hours after recovery from anesthesia, although earlier feeding has been studied. Infants who are fed earlier than 4 hours do not have a worse total clinical outcome; however, they do vomit more frequently and more severely, leading to significant discomfort for the patient and anxiety for the parents.

  • As many as 80% of patients continue to regurgitate after surgery; however, patients who continue to vomit 5 days after surgery may warrant further radiologic investigation.
  • Patients should be observed for surgical complications (eg, incomplete pyloromyotomy, mucosal perforation, bleeding) and may be discharged home when adequately hydrated and tolerating feedings well.
  • A study from the Children's Hospital of Philadelphia showed that infants fed ad libitum were able to tolerate full feedings sooner after laparoscopic pyloromyotomy, and the standardized feeding regimen had no advantage over ad libitum feedings.[10]
Next

Prognosis

  • Surgery is curative with minimal mortality.
  • The prognosis is very good, with complete recovery and catch-up growth if detected in a timely fashion.
Previous
 
Contributor Information and Disclosures
Author

Jagvir Singh, MD  Director, Division of Pediatric Emergency Medicine, Lutheran General Hospital of Park Ridge

Jagvir Singh, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Dara A Kass, MD  Clinical Assistant Instructor, Department of Emergency Medicine, State University of New York Downstate Medical Center, Kings County Hospital

Dara A Kass, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital, Western Australia; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Panteli C. New insights into the pathogenesis of infantile pyloric stenosis. Pediatr Surg Int. Sep 16 2009;[Medline].

  2. Rogers IM. The true cause of pyloric stenosis is hyperacidity. Acta Paediatr. Feb 2006;95(2):132-6. [Medline].

  3. Krogh C, Fischer TK, Skotte L, Biggar RJ, Oyen N, Skytthe A. Familial aggregation and heritability of pyloric stenosis. JAMA. Jun 16 2010;303(23):2393-9. [Medline].

  4. [Guideline] Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for hypertrophic pyloric stenosis. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2007 Nov 14. [Full Text].

  5. Maheshwari P, Abograra A, Shamam O. Sonographic evaluation of gastrointestinal obstruction in infants: a pictorial essay. J Pediatr Surg. Oct 2009;44(10):2037-42. [Medline].

  6. Aldridge RD, MacKinlay GA, Aldridge RB. Choice of incision: the experience and evolution of surgical management of infantile hypertrophic pyloric stenosis. J Laparoendosc Adv Surg Tech A. Feb 2007;17(1):131-6. [Medline].

  7. Leclair MD, Plattner V, Mirallie E, Lejus C, Nguyen JM, Podevin G. Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a prospective, randomized controlled trial. J Pediatr Surg. Apr 2007;42(4):692-8. [Medline].

  8. van den Ende ED, Allema JH, Hazebroek FW, Breslau PJ. Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital? Results from two teaching hospitals. Eur J Pediatr. Jun 2007;166(6):553-7. [Medline].

  9. Taqi E, Boutros J, Emil S, Dube S, Puligandla P, Flageole H. Evaluation of surgical approaches to pyloromyotomy: a single-center experience. J Pediatr Surg. May 2007;42(5):865-8. [Medline].

  10. Adibe OO, Nichol PF, Lim FY, Mattei P. Ad libitum feeds after laparoscopic pyloromyotomy: a retrospective comparison with a standardized feeding regimen in 227 infants. J Laparoendosc Adv Surg Tech A. Apr 2007;17(2):235-7. [Medline].

  11. Cohen HL, Blumer SL, Zucconi WB. The sonographic double-track sign: not pathognomonic for hypertrophic pyloric stenosis; can be seen in pylorospasm. J Ultrasound Med. May 2004;23(5):641-6. [Medline].

  12. Garcia VF, Randolph JG. Pyloric stenosis: diagnosis and management. Pediatr Rev. Apr 1990;11(10):292-6. [Medline].

  13. Godbole P, Sprigg A, Dickson JA. Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis. Arch Dis Child. Oct 1996;75(4):335-7. [Medline].

  14. Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis. Radiology. May 2003;227(2):319-31. [Medline].

  15. Hernanz-Schulman M, Sells LL, Ambrosino MM. Hypertrophic pyloric stenosis in the infant without a palpable olive: accuracy of sonographic diagnosis. Radiology. Dec 1994;193(3):771-6. [Medline].

  16. Huang YC, Su BH. Medical treatment with atropine sulfate for hypertrophic pyloric stenosis. Acta Paediatr Taiwan. May-Jun 2004;45(3):136-40. [Medline].

  17. Irish MS, Pearl RH, Caty MG, Glick PL. The approach to common abdominal diagnosis in infants and children. Pediatr Clin North Am. Aug 1998;45(4):729-72. [Medline].

  18. Kim SS, Lau ST, Lee SL. Pyloromyotomy: a comparison of laparoscopic, circumumbilical, and right upper quadrant operative techniques. J Am Coll Surg. Jul 2005;201(1):66-70. [Medline].

  19. Liacouras CA, Cook-Sather SD, Schreiner MS, Bellah RD. Endoscopic findings in hypertrophic pyloric stenosis: appearance in classic and evolving disease. Gastrointest Endosc. May 1997;45(5):371-4. [Medline].

  20. Nagita A, Yamaguchi J, Amemoto K, et al. Management and ultrasonographic appearance of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate. J Pediatr Gastroenterol Nutr. Aug 1996;23(2):172-7. [Medline].

  21. Schechter R, Torfs CP, Bateson TF. The epidemiology of infantile hypertrophic pyloric stenosis. Paediatr Perinat Epidemiol. Oct 1997;11(4):407-27. [Medline].

  22. Sorensen HT, Skriver MV, Pedersen L. Risk of infantile hypertrophic pyloric stenosis after maternal postnatal use of macrolides. Scand J Infect Dis. 2003;35(2):104-6. [Medline].

  23. Spinelli C, Bertocchini A, Massimetti M. Muscle thickness in infants hypertrophic pyloric stenosis. Pediatr Med Chir. Mar-Apr 2003;25(2):148-50. [Medline].

  24. Sretenovic A, Smoljanic Z, Korac G. [Conservative treatment of hypertrophic pyloric stenosis in children]. Srp Arh Celok Lek. Oct 2004;132 Suppl 1:93-6. [Medline].

  25. Takahashi T. Pathophysiological significance of neuronal nitric oxide synthase in the gastrointestinal tract. J Gastroenterol. 2003;38(5):421-30. [Medline].

  26. van der Bilt JD, Kramer WL, van der Zee DC. Early feeding after laparoscopic pyloromyotomy: the pros and cons. Surg Endosc. May 2004;18(5):746-8. [Medline].

  27. Vasavada P. Ultrasound evaluation of acute abdominal emergencies in infants and children. Radiol Clin North Am. Mar 2004;42(2):445-56. [Medline].

 
Previous
Next
 
Lateral view from an upper GI study demonstrates the double-track sign.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.