Definition
Hypertrophy of muscle layers at pyloric sphincterM:F 4:1 (especially first born males); presents at 2-4weeks; positive FHx
Differential diagnosis
- GERD
- Gastroenteritis
- Pyloric atresia
- Antral web
Clinical features
- Palpable mass (olive sign – right margin of rectus)
- Visible peristalsis (from LUQ to epigastrium)
- Projectile non-bilious vomiting after feeds
- Infant will be hungry and attempt to re-feed
- Constipation, FTT, wasting
- Dehydration (may lead to jaundice)
Investigations
- CBCD, lytes, Cr, BUN, glucose, ABG
- Hypochloremic hypokalemic metabolic alkalosis
Imaging
- Abdominal ultrasound – pyloric muscle thickness >4mm, length >16mm
- X-ray (barium) – string sign
Surgical treatment – pyloromyotomy