Pyloric stenosis
This leaflet explains pyloric stenosis, how it is treated and
what to expect when your child comes to Great Ormond Street Hospital.
Contents
What is pyloric stenosis?
This is when the passage between the stomach and small bowel (pylorus)
becomes narrower.
The passage is made up of muscle, which seems
to become thicker than usual, closing up the inside of the passage.
This stops milk or food passing into the bowel to be digested.
What are the symptoms of pyloric stenosis?
In most cases, a baby with pyloric stenosis will begin bringing
up small amounts of milk after feeding. Over a few days this will
become worse until the baby can no longer keep any milk down. This
vomiting may become so forceful that the milk may be projected
for several feet out of the baby’s mouth. This is called
projectile vomiting.
As the milk is lying in the acid in the stomach,
it can curdle and become yellow in colour. This also reduces
the amount of faeces (poo) passed, as little or no food is reaching
the bowel.
If the
condition is not treated, the baby will become dehydrated and
not gain weight. Signs of dehydration include lethargy, wet nappies
less frequently than normal and the soft spot (fontanel) on the
top of the head may be sunken.
What causes pyloric stenosis and how
common is it?
Pyloric stenosis is a fairly common reason for babies needing
an operation and develops in the first few weeks, usually around
six weeks after birth. We do not know exactly why pyloric stenosis
develops, but it tends to affect more boys than girls, and seems
to run in families too.
How is pyloric stenosis diagnosed?
The thickened pyloric muscle can be felt, especially during feeding,
as a small, hard lump on the right side of the baby’s stomach.
The muscles around the stomach can sometimes be seen straining,
moving from left to right as they try to push milk through the
pylorus.
Your child’s doctor will ask you lots of questions
and may want to examine your baby during a feed to observe any
vomiting.
Sometimes the doctors may want to confirm the diagnosis using
tests and scans. These can include an ultrasound scan, like the
ones used in pregnancy, to get a picture of the thickened muscle.
How is pyloric stenosis treated?
Pyloric stenosis is usually treated in an operation under general
anaesthetic, lasting about half an hour. The operation is called
a pyloromyotomy.
The effects of pyloric stenosis, like dehydration
due to the vomiting, can become serious quite quickly in children,
and so there are no alternatives to the operation.
What happens before the operation?
You will receive information about how to prepare your child for
the operation in your admission letter and our booklet Welcome
to GOSH: a guide for parents.
Your child’s surgeon will explain
the operation in detail, discuss any worries you may have and ask
your permission for the operation by asking you to sign a consent
form.
An anaesthetist will also see you to explain about your child’s
anaesthetic in more detail. If your child has any medical problems,
such as allergies, please tell the doctors.
If your child is dehydrated,
he or she will need a ‘drip’ of
fluids for a while before the operation. This will make sure that
your child’s blood contains the right balance of salts and
minerals, and treats the dehydration. Your child will have the
operation once his or her blood test results are normal. He or
she will also need a nasogastric tube, which is passed up the nose,
down the food-pipe and into the stomach. This will drain off the
stomach contents before the operation.
What does the operation involve?
The operation can either be carried out using traditional open
surgery or keyhole surgery - for more information, see our
leaflet Keyhole surgery: information for families.
The surgeon
will cut through some of the thickened muscle, which widens the
passage so that milk and food can pass into the bowel to be digested.
Your child will also be given some pain relief at the end of
the operation, which will last for six to eight hours.
Are there any risks?
All the doctors who perform this operation have had lots of experience,
which will minimise the chance of problems occurring.
All surgery
carries a small risk of bleeding during or after the operation.
There is a chance that the delicate lining of the bowel could
be damaged during the operation, but this is very rare. Every anaesthetic
carries a risk of complications but this is very small.
What happens afterwards?
Your child will come back to the ward to recover. He or she will
have been given pain relieving medications during the operation,
but these will begin to wear off. For the first few days, pain
relief will usually be given through a ‘drip’ and then,
when your child is more comfortable, in the form of medicines to
be swallowed.
For the first few hours, your child will continue
to have fluids through the drip so that the stomach and bowel
can start to heal. After a while, you can start to feed your child
again, starting with small amounts, and increasing the amount
as he or she tolerates it.
Your child may still bring some milk back up, but it will not
be the forceful projectile vomiting like before. This is due
to the ring of muscle at the top of the stomach being weak.
Your child
will be able to go home once he or she is feeding well and starting
to gain weight. We will contact your health visitor and GP (doctor)
to tell them about the operation.
When you get home
Your child’s abdomen may feel sore for a while after the
operation, but wearing loose clothes can help. Your child will
need to have regular pain relief for at least three days, and we
will give you the medications to take home with you.
The stitches
used during the operation will dissolve on their own so there
is no need to have them removed. If possible, keep the operation
site clean and dry for two to three days, to allow the operation
site heal properly.
When your child has a bath, do not
soak the area until the operation site has settled down.
You may need to come back tohospital for an outpatient appointment after the operation. We will send you the appointment date in the post.
What is the outlook for children
with pyloric stenosis?
Most pyloric stenosis operations are successful, with the immediate
effect of reducing or stopping completely any vomiting after feeds.
Support group
Gut Motility Disorders Support Network
Westcott Farm
Oakford
Tiverton EX16 9EZ
Tel: 01398 351173
Email:
help@gmdnet.org.uk
Ref: F040097 © GOSH Trust 2003
Compiled by the General Surgery Department and the Pain Service, in collaboration with the Child and Family Information Group.
This information does not constitute health or medical
advice and will not necessarily reflect treatment at other hospitals.
If you have any questions, please ask your doctor. No liability can be
taken as a result of using this information.
This page was last updated on 12 August, 2008
UCL Institute of Child Health
Great Ormond Street Hospital for Children NHS Trust
