Pyloric Stenosis

Abstract

Abstract Pyloric stenosis is a medical neonatal emergency that requires stabilization and eventual surgical intervention within the first few weeks of life. It is a result of idiopathic thickening of the pyloric musculature, leading to a gastric outlet obstruction syndrome. Infants present with projectile vomiting and various degrees of dehydration and metabolic derangements. Vomiting leads to hypochloremia hypokalemic metabolic alkalosis because of the depletion of gastric contents, which contains sodium, potassium, and hydrochloric acid. It is relatively common, with an incidence of 2 to 4 per 1000 live births, with a male predominance. It is crucial that before proceeding to the operating room, infants are resuscitated appropriately, and their electrolyte derangements have normalized. These infants are at high risk for aspiration because of the incomplete gastric emptying, therefore prompting the importance of preinduction suctioning of the stomach and consideration of a rapid sequence induction. The use of intravenous opioids should be avoided because of an increased risk of apnea and delayed awakening due to the persistent pH derangement in the cerebrospinal fluid. Extubation occurs at the end of the procedure when infants are fully awake with intact airway reflexes. Premature neonates less than 44–60 weeks of gestation should receive appropriate monitoring for postoperative apnea. Oral feeds are usually resumed 4 to 6 hours after surgery.