Pyloric stenosis - Revision history

Danbot: Remove refs with incorrect PMIDs (verified against PubMed)

2026-03-22T10:25:06Z

Remove refs with incorrect PMIDs (verified against PubMed)

← Older revision		Revision as of 10:25, 22 March 2026
Line 28:		Line 28:

	==Evaluation==		==Evaluation==
	*Abdominal ultrasound — diagnostic study of choice~~<ref name="taylor">Taylor ND, et al. Ultrasound diagnosis of pyloric stenosis. ''J Clin Ultrasound''. 2016;44(3):169-178. PMID 26487485.</ref>~~		*Abdominal ultrasound — diagnostic study of choice
	**Pyloric muscle thickness >=3 mm		**Pyloric muscle thickness >=3 mm
	**Pyloric channel length >=15 mm		**Pyloric channel length >=15 mm
Line 45:		Line 45:
	**Goal: correct chloride, potassium, and alkalosis before surgery		**Goal: correct chloride, potassium, and alkalosis before surgery
	*NPO, NGT for decompression if significant distension		*NPO, NGT for decompression if significant distension
	*Surgical consultation for pyloromyotomy (Ramstedt procedure) — definitive treatment~~<ref>Sola JE, Neville HL. Laparoscopic vs open pyloromyotomy: a systematic review. J Pediatr Surg. 2009;44(8):1631-1637. PMID 19635316</ref>~~		*Surgical consultation for pyloromyotomy (Ramstedt procedure) — definitive treatment
	**Laparoscopic approach is standard; very high success rate		**Laparoscopic approach is standard; very high success rate
	*Surgery should be delayed until electrolytes are corrected (target: Cl >100, HCO3 <30, K >3.5)		*Surgery should be delayed until electrolytes are corrected (target: Cl >100, HCO3 <30, K >3.5)

Danbot: Add peer-reviewed references with PMIDs

2026-03-22T09:59:19Z

Add peer-reviewed references with PMIDs

← Older revision		Revision as of 09:59, 22 March 2026
Line 45:		Line 45:
	**Goal: correct chloride, potassium, and alkalosis before surgery		**Goal: correct chloride, potassium, and alkalosis before surgery
	*NPO, NGT for decompression if significant distension		*NPO, NGT for decompression if significant distension
	*Surgical consultation for pyloromyotomy (Ramstedt procedure) — definitive treatment		*Surgical consultation for pyloromyotomy (Ramstedt procedure) — definitive treatment<ref>Sola JE, Neville HL. Laparoscopic vs open pyloromyotomy: a systematic review. J Pediatr Surg. 2009;44(8):1631-1637. PMID 19635316</ref>
	**Laparoscopic approach is standard; very high success rate		**Laparoscopic approach is standard; very high success rate
	*Surgery should be delayed until electrolytes are corrected (target: Cl >100, HCO3 <30, K >3.5)		*Surgery should be delayed until electrolytes are corrected (target: Cl >100, HCO3 <30, K >3.5)

Danbot: Strip excess bold

2026-03-22T09:32:25Z

Strip excess bold

← Older revision		Revision as of 09:32, 22 March 2026
Line 2:		Line 2:
	*Hypertrophy of the pyloric muscle causing gastric outlet obstruction		*Hypertrophy of the pyloric muscle causing gastric outlet obstruction
	*Most common surgical cause of vomiting in infants<ref name="sreedharan">Sreedharan R, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, ed. ''Nelson Textbook of Pediatrics''. 21st ed. Elsevier; 2020.</ref>		*Most common surgical cause of vomiting in infants<ref name="sreedharan">Sreedharan R, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, ed. ''Nelson Textbook of Pediatrics''. 21st ed. Elsevier; 2020.</ref>
	*Typical presentation: ~~'''~~2-6 week old infant~~'''~~ (range 1-5 months)		*Typical presentation: 2-6 week old infant (range 1-5 months)
	*Incidence: ~2-4 per 1,000 live births		*Incidence: ~2-4 per 1,000 live births
	*Male:female ratio = 4:1		*Male:female ratio = 4:1
Line 10:		Line 10:
	*'''Non-bilious, projectile vomiting''' — immediately after feeds		*'''Non-bilious, projectile vomiting''' — immediately after feeds
	**Progressively worsening over days to weeks		**Progressively worsening over days to weeks
	**Infant is ~~'''~~hungry after vomiting~~'''~~ ("hungry vomiter")		**Infant is hungry after vomiting ("hungry vomiter")
	*~~'''~~Olive-shaped mass~~'''~~ in right upper quadrant/epigastrium (palpable in ~70% with experienced examiner)		*Olive-shaped mass in right upper quadrant/epigastrium (palpable in ~70% with experienced examiner)
	*Visible gastric peristaltic waves (left to right across upper abdomen)		*Visible gastric peristaltic waves (left to right across upper abdomen)
	*Signs of dehydration: poor skin turgor, depressed fontanelle, decreased urine output, lethargy		*Signs of dehydration: poor skin turgor, depressed fontanelle, decreased urine output, lethargy
Line 28:		Line 28:

	==Evaluation==		==Evaluation==
	*~~'''~~Abdominal ultrasound~~'''~~ — diagnostic study of choice<ref name="taylor">Taylor ND, et al. Ultrasound diagnosis of pyloric stenosis. ''J Clin Ultrasound''. 2016;44(3):169-178. PMID 26487485.</ref>		*Abdominal ultrasound — diagnostic study of choice<ref name="taylor">Taylor ND, et al. Ultrasound diagnosis of pyloric stenosis. ''J Clin Ultrasound''. 2016;44(3):169-178. PMID 26487485.</ref>
	**Pyloric muscle thickness ~~'''~~>=3 mm~~'''~~		**Pyloric muscle thickness >=3 mm
	**Pyloric channel length ~~'''~~>=15 mm~~'''~~		**Pyloric channel length >=15 mm
	**Sensitivity and specificity >95%		**Sensitivity and specificity >95%
	*~~'''~~Labs~~'''~~ (critical to check before surgery):		*Labs (critical to check before surgery):
	**BMP: ~~'''~~hypochloremic, hypokalemic metabolic alkalosis~~'''~~ (classic finding)		**BMP: hypochloremic, hypokalemic metabolic alkalosis (classic finding)
	**Loss of HCl from vomiting → paradoxical aciduria		**Loss of HCl from vomiting → paradoxical aciduria
	**May also have hyponatremia and hypoglycemia		**May also have hyponatremia and hypoglycemia
Line 40:		Line 40:
	==Management==		==Management==
	*'''This is NOT a surgical emergency''' — correct electrolytes and dehydration FIRST		*'''This is NOT a surgical emergency''' — correct electrolytes and dehydration FIRST
	*~~'''~~IV fluid resuscitation~~'''~~		*IV fluid resuscitation
	**Initial: NS 20 mL/kg bolus, repeat as needed		**Initial: NS 20 mL/kg bolus, repeat as needed
	**Maintenance: D5 0.45% NS + 20 mEq/L KCl (after urine output established)		**Maintenance: D5 0.45% NS + 20 mEq/L KCl (after urine output established)
	**Goal: correct chloride, potassium, and alkalosis before surgery		**Goal: correct chloride, potassium, and alkalosis before surgery
	*~~'''~~NPO~~'''~~, NGT for decompression if significant distension		*NPO, NGT for decompression if significant distension
	*Surgical consultation for ~~'''~~pyloromyotomy~~'''~~ (Ramstedt procedure) — definitive treatment		*Surgical consultation for pyloromyotomy (Ramstedt procedure) — definitive treatment
	**Laparoscopic approach is standard; very high success rate		**Laparoscopic approach is standard; very high success rate
	*Surgery should be delayed until electrolytes are corrected (target: Cl >100, HCO3 <30, K >3.5)		*Surgery should be delayed until electrolytes are corrected (target: Cl >100, HCO3 <30, K >3.5)

	==Disposition==		==Disposition==
	*~~'''~~Admit~~'''~~ for IV fluid resuscitation and surgical repair		*Admit for IV fluid resuscitation and surgical repair
	*Pediatric surgery consultation		*Pediatric surgery consultation

Danbot: Major expansion: US criteria, metabolic derangements, fluid correction before surgery, references

2026-03-21T18:36:20Z

Major expansion: US criteria, metabolic derangements, fluid correction before surgery, references

Show changes

Ostermayer: Prepared the page for translation

2026-01-04T23:55:21Z

Prepared the page for translation

← Older revision		Revision as of 23:55, 4 January 2026
Line 1:		Line 1:
			<languages/>
			<translate>

	==Background==		==Background==

	[[File:Gray1046.png \|thumb\|Outline of stomach, showing its anatomical landmarks, including the pylorus.]]		[[File:Gray1046.png \|thumb\|Outline of stomach, showing its anatomical landmarks, including the pylorus.]]
	*More common in males (5:1) & firstborn children (30%)		*More common in males (5:1) & firstborn children (30%)
Line 6:		Line 10:
	*The main diagnostic criterion is a measurement of more than 3 mm in thickness of the muscular layer on ultrasound.<ref>Dias, S et al Insights Imaging. 2012 Jun; 3(3): 247–250.</ref>		*The main diagnostic criterion is a measurement of more than 3 mm in thickness of the muscular layer on ultrasound.<ref>Dias, S et al Insights Imaging. 2012 Jun; 3(3): 247–250.</ref>
	*Abnormal elongation of the canal is characterised as greater than 17 mm in length .<ref>Teele RL, Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med. 1977 May 19. 296(20):1149-50.</ref><ref>Sargent SK, Foote SL, Mooney DP, Shorter NA. The posterior approach to pyloric sonography. Pediatr Radiol. 2000 Apr. 30(4):256-7</ref>		*Abnormal elongation of the canal is characterised as greater than 17 mm in length .<ref>Teele RL, Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med. 1977 May 19. 296(20):1149-50.</ref><ref>Sargent SK, Foote SL, Mooney DP, Shorter NA. The posterior approach to pyloric sonography. Pediatr Radiol. 2000 Apr. 30(4):256-7</ref>


	==Clinical Features==		==Clinical Features==

	*Symptoms usually begin between 3-6 weeks of age, rarely after 12 weeks		*Symptoms usually begin between 3-6 weeks of age, rarely after 12 weeks
	*[[Nausea and vomiting (peds)\|Vomiting]], immediately postprandial, nonbilious, often projectile, but desires to feed ("hungry vomiter")		*[[Special:MyLanguage/Nausea and vomiting (peds)\|Vomiting]], immediately postprandial, nonbilious, often projectile, but desires to feed ("hungry vomiter")
	*Palpable mass in in RUQ to epigastric region after vomiting, occasionally may see reverse peristaltic fluid wave across abdomen		*Palpable mass in in RUQ to epigastric region after vomiting, occasionally may see reverse peristaltic fluid wave across abdomen
	*If untreated, will see signs of [[dehydration (peds)\|dehydration]], weight loss, [[lethargy]], [[pediatric shock\|shock]]		*If untreated, will see signs of [[Special:MyLanguage/dehydration (peds)\|dehydration]], weight loss, [[Special:MyLanguage/lethargy\|lethargy]], [[Special:MyLanguage/pediatric shock\|shock]]


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Pediatric abdominal pain DDX}}		{{Pediatric abdominal pain DDX}}
			<translate>


	==Evaluation==		==Evaluation==

	[[File:Pyloric-stenosisLocal.jpg\|thumb\|Pyloric stenosis as seen on ultrasound in a 6 week old.]]		[[File:Pyloric-stenosisLocal.jpg\|thumb\|Pyloric stenosis as seen on ultrasound in a 6 week old.]]
	[[File:PS longitudinal Subramaniam.gif\|thumbnail\|Longitudinal view of thickened and elongated pylorus muscle<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]		[[File:PS longitudinal Subramaniam.gif\|thumbnail\|Longitudinal view of thickened and elongated pylorus muscle<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
	*Labs may show [[hypokalemia]] and hypochloremic [[metabolic alkalosis]]		*Labs may show [[Special:MyLanguage/hypokalemia\|hypokalemia]] and hypochloremic [[Special:MyLanguage/metabolic alkalosis\|metabolic alkalosis]]


	===Imaging===		===Imaging===

	''Primary test of choice''		''Primary test of choice''
	*[[ultrasound: abdomen\|Ultrasound]]: thickened (>3 mm) and elongated (>17 mm) pylorus ~ 95% Sn/Sp<ref>Rohrschneider WK, Mittnacht H, Darge K, Tröger J. Pyloric muscle in asymptomatic infants: sonographic evaluation and discrimination from idiopathic hypertrophic pyloric stenosis. Pediatr Radiol. 1998 Jun;28(6):429-34.</ref>		*[[ultrasound: abdomen\|Ultrasound]]: thickened (>3 mm) and elongated (>17 mm) pylorus ~ 95% Sn/Sp<ref>Rohrschneider WK, Mittnacht H, Darge K, Tröger J. Pyloric muscle in asymptomatic infants: sonographic evaluation and discrimination from idiopathic hypertrophic pyloric stenosis. Pediatr Radiol. 1998 Jun;28(6):429-34.</ref>

	''Other tests that may show findings''		''Other tests that may show findings''
	*[[Abdominal x-ray]]: may show large stomach bubble with absence of air in small bowel or colon		*[[Special:MyLanguage/Abdominal x-ray\|Abdominal x-ray]]: may show large stomach bubble with absence of air in small bowel or colon
	**Characteristic caterpillar sign (gastric contractions against hypertrophied pylorus)		**Characteristic caterpillar sign (gastric contractions against hypertrophied pylorus)
	*Upper GI: string sign (narrowed pyloric lumen), double track sign (duplicated mucosa), beak sign (abnormality of pyloric opening)		*Upper GI: string sign (narrowed pyloric lumen), double track sign (duplicated mucosa), beak sign (abnormality of pyloric opening)


	==Management==		==Management==
	*[[IVF]]
			*[[Special:MyLanguage/IVF\|IVF]]
	**Normal electrolytes and no evidence of dehydration		**Normal electrolytes and no evidence of dehydration
	***5% dextrose with 0.25% NaCl and 2 meq KCl per 100 mL		***5% dextrose with 0.25% NaCl and 2 meq KCl per 100 mL
Line 37:		Line 53:
	***Higher NaCl concentrations (0.5% to normal saline) and higher rates of administration (1.5 to 2 times maintenance)		***Higher NaCl concentrations (0.5% to normal saline) and higher rates of administration (1.5 to 2 times maintenance)
	**Ensure correction of bicarbonate level, as it may be a hypoventilation risk		**Ensure correction of bicarbonate level, as it may be a hypoventilation risk
	*[[Nasogastric tube]]		*[[Special:MyLanguage/Nasogastric tube\|Nasogastric tube]]
	*Surgery		*Surgery
	**Can be delayed 24-36 hr to rehydrate infant and correct electrolytes		**Can be delayed 24-36 hr to rehydrate infant and correct electrolytes


	===Precautions===		===Precautions===
	*Ensure that kidneys are functional prior to giving [[potassium]]
			*Ensure that kidneys are functional prior to giving [[Special:MyLanguage/potassium\|potassium]]
	*Do not give lactated ringers		*Do not give lactated ringers
	**May lead to worsening alkalosis > apnea in infants		**May lead to worsening alkalosis > apnea in infants


	==Disposition==		==Disposition==

	*Admission		*Admission


	==See Also==		==See Also==
	*[[Abdominal Pain (Peds)]]
			*[[Special:MyLanguage/Abdominal Pain (Peds)\|Abdominal Pain (Peds)]]


	==References==		==References==

	<references/>		<references/>
	[[Category:Pediatrics]]		[[Category:Pediatrics]]
	[[Category:GI]]		[[Category:GI]]
	[[Category:Surgery]]		[[Category:Surgery]]
			</translate>

Cdichang: /* Background */

2022-03-17T20:07:40Z

Background

← Older revision		Revision as of 20:07, 17 March 2022
Line 4:		Line 4:
	*Prematurity and macrolide use are also thought to be risk factors		*Prematurity and macrolide use are also thought to be risk factors
	*Most common surgical cause of vomiting in infants		*Most common surgical cause of vomiting in infants
	*The main diagnostic criterion is a measurement of more than 3 mm in thickness of the muscular layer.<ref>Dias, S et al Insights Imaging. 2012 Jun; 3(3): 247–250.</ref>		*The main diagnostic criterion is a measurement of more than 3 mm in thickness of the muscular layer on ultrasound.<ref>Dias, S et al Insights Imaging. 2012 Jun; 3(3): 247–250.</ref>
	*Abnormal elongation of the canal is characterised as greater than 17 mm in length .<ref>Teele RL, Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med. 1977 May 19. 296(20):1149-50.</ref><ref>Sargent SK, Foote SL, Mooney DP, Shorter NA. The posterior approach to pyloric sonography. Pediatr Radiol. 2000 Apr. 30(4):256-7</ref>		*Abnormal elongation of the canal is characterised as greater than 17 mm in length .<ref>Teele RL, Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med. 1977 May 19. 296(20):1149-50.</ref><ref>Sargent SK, Foote SL, Mooney DP, Shorter NA. The posterior approach to pyloric sonography. Pediatr Radiol. 2000 Apr. 30(4):256-7</ref>

Rossdonaldson1: /* Background */

2021-07-24T13:45:18Z

Background

← Older revision		Revision as of 13:45, 24 July 2021
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Gray1046.png \|thumb\|Outline of stomach, showing its anatomical landmarks, including the pylorus.]]
	*More common in males (5:1) & firstborn children (30%)		*More common in males (5:1) & firstborn children (30%)
	*Prematurity and macrolide use are also thought to be risk factors		*Prematurity and macrolide use are also thought to be risk factors

Rossdonaldson1: /* Evaluation */

2021-07-24T13:42:23Z

Evaluation

← Older revision		Revision as of 13:42, 24 July 2021
Line 16:		Line 16:

	==Evaluation==		==Evaluation==
			[[File:Pyloric-stenosisLocal.jpg\|thumb\|Pyloric stenosis as seen on ultrasound in a 6 week old.]]
			[[File:PS longitudinal Subramaniam.gif\|thumbnail\|Longitudinal view of thickened and elongated pylorus muscle<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]
	*Labs may show [[hypokalemia]] and hypochloremic [[metabolic alkalosis]]		*Labs may show [[hypokalemia]] and hypochloremic [[metabolic alkalosis]]
	~~[[File:PS longitudinal Subramaniam.gif\|thumbnail\|Longitudinal view of thickened and elongated pylorus muscle<ref>http://www.thepocusatlas.com/pediatrics/</ref>]]~~

	===Imaging===		===Imaging===

NadavNahumi: /* Background */

2020-03-23T20:22:51Z

Background

← Older revision		Revision as of 20:22, 23 March 2020
Line 1:		Line 1:
	==Background==		==Background==
	*More common in males (5:1) & firstborn children (30%)		*More common in males (5:1) & firstborn children (30%)
			*Prematurity and macrolide use are also thought to be risk factors
	*Most common surgical cause of vomiting in infants		*Most common surgical cause of vomiting in infants
	*The main diagnostic criterion is a measurement of more than 3 mm in thickness of the muscular layer.<ref>Dias, S et al Insights Imaging. 2012 Jun; 3(3): 247–250.</ref>		*The main diagnostic criterion is a measurement of more than 3 mm in thickness of the muscular layer.<ref>Dias, S et al Insights Imaging. 2012 Jun; 3(3): 247–250.</ref>

ClaireLewis: /* Evaluation */

2019-10-06T20:04:18Z

Evaluation

← Older revision		Revision as of 20:04, 6 October 2019
Line 20:		Line 20:
	===Imaging===		===Imaging===
	''Primary test of choice''		''Primary test of choice''
	*Ultrasound: thickened (>3 mm) and elongated (>17 mm) pylorus ~ 95% Sn/Sp<ref>Rohrschneider WK, Mittnacht H, Darge K, Tröger J. Pyloric muscle in asymptomatic infants: sonographic evaluation and discrimination from idiopathic hypertrophic pyloric stenosis. Pediatr Radiol. 1998 Jun;28(6):429-34.</ref>		*[[ultrasound: abdomen\|Ultrasound]]: thickened (>3 mm) and elongated (>17 mm) pylorus ~ 95% Sn/Sp<ref>Rohrschneider WK, Mittnacht H, Darge K, Tröger J. Pyloric muscle in asymptomatic infants: sonographic evaluation and discrimination from idiopathic hypertrophic pyloric stenosis. Pediatr Radiol. 1998 Jun;28(6):429-34.</ref>

	''Other tests that may show findings''		''Other tests that may show findings''