Pyloric Stenosis

They talk about the stroke belt, an area in the southeastern United States where many develop hypertension and diabetes. This is thought to be because of the historically large amount of cholesterol containing fried foods. Well, we live in a pyloric stenosis belt and I don't think it is because of what babies eat.

Pyloric stenosis represents hypertrophy of a muscular band at the outlet of the stomach. These patients, usually boys, begin to vomit during their first two months of life. Because of the obstruction to outflow from the stomach, these babies become dehydrated and develop a metabolic alkalosis. Most are diagnosed within the first week after they begin to vomit. This reduces the amount of dehydration, but the infants inevitably need substantial IV fluids before coming to the hospital.

The surgical treatment of patients with pyloric stenosis is straight forward. the anesthetic management is not. Infants still die in the United States because of attempts to manage cases in medical centers that have little to no experience with newborns. This is usually because a surgeon feels that they can take care of a child but doesn't consider the other health care professionals involved in the babies management. This case should only be done in centers that have substantial experience with babies and especially anesthesiologists that take care of infants as a regular part of their practice.

I have written several things on the Infant with Pyloric Stenosis. You can find them at Wildcat Anesthesia.com in the Pediatric Anesthesia Subsection.

Rae Brown, MD