Infantile Hypertrophic Pyloric Stenosis - Causes, Signs, and Treatment

Introduction

Infantile hypertrophic pyloric stenosis is one of infants' most commonly seen gastrointestinal complex. It obstructs the gastrointestinal complex in children. Infantile hypertrophic pyloric stenosis is one of the major causes of non-bilious vomiting in children. Other signs and symptoms are abdominal distention and bleeding caused by secondary inflammation. It has a slight gender prevalence in males and children with B and O blood groups. There is the presence of abnormal muscle intervention, which may or may not be projectile initially. There is hypertrophy of muscular layers of the pylorus due to obstruction of gastric outlets. Infantile hypertrophic pyloric stenosis can cause various complications and lead to a surgical emergency.

What Is Infantile Pyloric Stenosis?

Infantile pyloric stenosis, also known as hypertrophic pyloric stenosis, is a disease affecting the pylorus muscle of infants. The pylorus muscle sphincter is present at the bottom of the stomach. A muscular valve allows food to pass from the stomach to the small intestine's top. The pylorus contracts when food is required to be digested and relaxes when food passes to the small intestine. In this condition, the pylorus muscle thickens, which causes obstruction, and the thickening results in the narrowing of the passway. There is a blockage of reaching food to the intestine. The pyloric muscles become abnormally large, leading to projectile vomiting and dehydration.

What Are the Causes of Infantile Pyloric Stenosis?

Infantile pyloric stenosis is a multifactorial disease. Various factors, such as genetic and environmental predisposition, are associated with this condition's etiology. The following are the causes of infantile pyloric stenosis in children.

• Abnormal muscle innervation.

• Maternal smoking.

• Maternal stress during the third trimester.

• Elevated serum levels.

• Decreased level of pyloric nitric oxide synthase.

• Infant hypergastrinemia.

• Macrolide antibiotics.

• Cow milk protein allergy.

What Are the Risk Factors for Infantile Pyloric Stenosis?

Following are the risk factors associated with the development of pyloric stenosis.

• Gender - The prevalence is high in male babies when compared to the female child.

• Race - It is more commonly seen in European descendants.

• Family History - There is a presence of genetic predisposition to this disease. The infant is at three times higher risk of developing this disease if their parents suffer from pyloric stenosis.

• Smoking - The child is at higher risk of pyloric stenosis if mothers smoke during pregnancy.

• Feeding - The approach to feeding habits increases the risk of this disease. Drinking formula is found to be increasing the risk of pyloric stenosis.

• Antibiotics - Infants who are administered antibiotics right after their birth are at high risk of developing this disease. Macrolide antibiotics such as Erythromycin and Azithromycin, if given to infants during the second week of their birth, increase the risk of infantile hypertrophic pyloric stenosis.

• Medications - Infants whose mothers take certain medications, such as Erythromycin, are at higher risk of developing pyloric stenosis during their late pregnancy.

• Premature Birth - Infantile pyloric stenosis is commonly seen in infants who have a premature birth.

What Are the Signs and Symptoms of Infantile Pyloric Stenosis?

The clinical features are seen in the child during the second to the eighth week of birth. Following are the various signs and symptoms of infantile pyloric stenosis;

• Presence of frequent projecting vomiting.

• The vomiting is infrequent, initially non-bloody and non-bilious.

• In the later stage, vomiting becomes frequent within an hour after eating, and its intensity increases.

• A wave-like motion in the stomach is seen after eating.

• Presence of small stools.

• Presence of slight hematemesis.

• Presence of abdominal pain.

• Dehydration.

• Weight loss.

• Irritability.

• Malnutrition.

• Metabolic alterations.

• The child is lazy.

• The child feels hungry after feeding.

• There is the presence of jaundice. The skin and eyes of the child appear yellow.

• The child urinates less frequently.

How Is the Condition Diagnosed?

The diagnosis is made through a complete physical examination, ultrasound, and upper gastrointestinal study.

• Physical Examination: The physician checks for the presence of dry lips and mouth, the absence of tears while crying, and lethargy if diagnosed lately.

• Ultrasound Scan: The ultrasound image shows enlarged pyloric muscle.

• Upper Gastrointestinal Study: UGI study shows an enlarged stomach with narrowing of the pyloric channel.

What Are the Complications of Infantile Pyloric Stenosis?

Following are the various complications of Infantile pyloric stenosis;

• Growth: Infantile pyloric stenosis leads to failure of growth and development of the child.

• Gastric Irritation: The child's stomach is irritated by repeated vomiting. Repeated vomiting may cause persistent gastric irritation, leading to mild bleeding.

• Dehydration: There is the presence of severe dehydration and electrolyte imbalance due to the presence of frequent vomiting.

• Vital Functions: Vital functions are affected in infantile pyloric stenosis. Electrolyte balance plays an important role in vital functions. The imbalance of electrolytes affects vital functioning in the child.

• Jaundice: Yellowish discoloration of the skin and eyes is seen in a child suffering from infantile pyloric stenosis.

What Are the Treatment Plans for Infantile Pyloric Stenosis?

Surgical intervention is required for the treatment of Infantile pyloric stenosis. Usually, surgery is performed the same day as a diagnosis if the child is hydrated and has proper electrolyte balance. However, fluid replacement is done before the child's surgery if the child is dehydrated. Pyloromyotomy is indicated for the relief of the child. The outside layer of the thickened pylorus muscle is being incised. It allows the inner lining to bulge out and open a channel for the passage of food. Pyloromyotomy is a minimally invasive surgery. A laparoscope is a slender viewing instrument inserted through a small incision in the navel of the child. The child's recovery is rapid, leaving a small scar. After surgery, the child is given intravenous fluid for a few hours. The baby starts feeding within 24 hours of surgery.

Conclusion

Infantile hypertrophic pyloric stenosis is most commonly seen in infants after birth. There is hypertrophy and hyperplasia of pyloric smooth muscle, resulting in gastric obstruction. There is frequent non-bilious vomiting in infants. Accurate assessment of fluid and electrolyte balance is maintained. The polygenic inheritance pattern is one of the major predisposing factors to this disease. This condition results in hypokalemic, hypochloremic metabolic acidosis. Surgical intervention is indicated. A laboratory investigation is required for the assessment of dehydration and electrolyte imbalance. Surgery relieves the child, and muscles are opened to restore the food path. The proper diagnosis, treatments, and parents' support are necessary for a better prognosis for the child.