Hypertrophic pyloric stenosis

Abstract

A disorder produced by hypertrophy of pyloric muscle, which generates progressive blockage of gastric emptying. The specific etiology is currently unknown, although there are hypotheses that seek to explain its origin. Most of the cases are presented around 4 weeks of life, affecting mainly males, white, first-born, rural population and bottle-fed, and there is a clear family predisposition. Vomiting is a constant symptom and characteristically is inmediately postprandial, often in projectile and not bilious, which could trigger dehydration, malnutrition, metabolic and hydroelectrolyte alterations. In a patient whom presents this clinic, finding distension, peristaltic gastric waves and palpation of pyloric olive mass, can be diagnosed in most of the patients. In case of doubt, ultrasound can be use, that currently is the Gold Standart. The initial management should be the metabolic and hydroelectrolytic correction and subsequently the definitive surgical treatment; Ramstedt pyloromyotomy, after decades, continuous as the procedure o choice, althought new studies shown promising results with other surgical thechniques.