pyloric stenosis

Pyloric stenosis: description

In the pyloric stenosis, also called Magenpförtnerkrampf, the stomach outlet (pylorus) is narrowed by a thickened muscles. As a result, ingested food can not be transported further into the duodenum. The typical symptom of pyloric stenosis is that the children vomit shortly after eating. About three out of every 1000 newborns develop pyloric stenosis. It is thus no rare disease and affects boys about four times more often than girls. The pyloric stenosis is relatively common in Europeans, but rare in Asians and Africans. A pyloric stenosis should be treated quickly, because the inadequate food intake can lead to severe metabolic imbalances. For treatment is usually a small surgical procedure in which the bottleneck is released.

Pyloric stenosis: symptoms

The pyloric stenosis is in the form of vomiting, which occurs about half an hour after meals. It is characteristic of the pyloric stenosis that the child vomits strong and gushing at short intervals. The vomit smells strongly sour and may contain blood stains due to the stomach irritation. The thickened stomach outlet can often be felt from the outside as an olive-shaped structure in the right upper abdomen, especially if the child has just vomited and the stomach is empty. In addition, one can sometimes observe the pronounced movements of the stomach muscles (gastric peristalsis) as a wave-like movement in the upper abdomen of the child.

Due to the stomach emptying disorder, the children develop a massive lack of food and fluids within a few hours. They are therefore very restless and often drink conspicuously greedy. As gastric acid is additionally vomited, the pH value (acidity) in the blood shifts to the alkaline range (metabolic alkalosis). As a result of the pyloric stenosis, the affected children lose a lot of weight.

At the same time they produce less urine, since they can hardly absorb liquid. When pyloric stenosis typical signs of dehydration (exsiccosis) can be observed: Noticeable are deep dark circles, a sunken fontanelle and wrinkles on the face. The mucous membranes are dry and so-called standing skin folds form. This means that the skin of the child remains as a fold of skin due to the lack of fluid, if you gently grab it with two fingers. Standing skin folds are a serious sign of a severe dehydration of the child, which must be treated promptly.

The children have severe pain in the upper abdomen due to the repeated vomiting and a visibly tormented expression with a frown. Occasionally the children’s skin turns yellow (jaundice, jaundice). If the children vomit less during the course of the disease, this must by no means be misinterpreted as improvement. It is rather an expression of the exhaustion and dehydration of the child. Immediate medical examination and treatment is urgently needed.

Pyloric stenosis: causes and risk factors

The pylorus is a ring-shaped muscle between the stomach outlet and the duodenum. It is important for controlled gastric emptying. In the case of pyloric stenosis, spasm (spasm) of the circular musculature at the stomach outlet occurs again and again for reasons that are not yet clear. These cramps lead after some time to an increase in thickness of the circular muscle (hypertrophy), so that little or no porridge can pass through the stomach outlet. This results in a gastric emptying disorder. The more food that accumulates in the process, the more pressure develops in the stomach until the child finally vomits all the food it has taken.

The exact cause of the pyloric stenosis is not yet clear. However, various causes are discussed: Among other things, a false innervation of the pyloric muscles could be the cause. It is also possible that the system is hereditary for a pyloric stenosis, as the disease occurs familial. In addition, children with blood type B and O are more frequently affected than children with other blood types.

Pyloric stenosis: examinations and diagnosis

The diagnosis of pyloric stenosis can be confirmed by the typical symptoms and by ultrasound. In ultrasound, the pyloric musculature (stomach jaw) looks thickened. In addition, one can measure the thickness of the muscles in the ultrasound: A pyloric stenosis is present when in the ultrasound image of the sphincter muscle (pylorus) is longer than sixteen millimeters and the wall thickness is more than four millimeters. In newborns younger than one month and in premature babies, these measures are slightly lower. If a clear diagnosis by ultrasound and on the basis of the symptoms is not possible, an X-ray contrast agent examination can additionally be carried out.

Diseases similar to pyloric stenosis

Food intolerances, poisoning or nutritional deficiencies can cause similar symptoms to pyloric stenosis. Gastrointestinal infections and reflux disease (reflux of gastric contents into the esophagus) may also be the cause of vomiting. In addition, metabolic diseases should also be considered. Some metabolic disorders are recorded as part of the neonatal screening and can therefore usually be ruled out early as the cause of the symptoms.

Congenital anomalies, such as a so-called tracheoesophageal fistula, in which the esophagus is connected to the trachea, sometimes appear together with pyloric stenosis, for reasons which are unexplained.

Pyloric stenosis: treatment

In most cases, the pyloric stenosis (Magenpförtnerkrampf) is operated. Before the operation can be performed, however, the fluid and electrolyte balance of the child must be re-balanced with infusions. Immediately prior to the operation, the stomach is also emptied using a gastric tube so that no stomach contents can enter the trachea during the operation.

The operation of choice is the so-called Weber-Ramstedt pylorotomy, in which all muscle fibers of the stomach outlet are severed longitudinally with the scalpel, without injuring the mucous membrane. This technique increases the diameter of the stomach outlet so that the porridge can pass through normally again. The operation shows very good results, so that the children usually develop completely normal after the procedure. In the first period after the operation, the child should be fed with small, easily digestible meals in the form of mother’s or baby’s milk.

Doctors recommend an early surgery, because the general condition of the child in an early disease phase is usually still good. Good general condition significantly reduces the risk of surgery. The operation can be performed by a small incision endoscopically (laparoscopy, “keyhole technique”) as well as by an operative opening of the upper abdomen (laparotomy). The advantage of laparoscopic surgery is that children usually have less pain and less vomiting. Overall, the pylorotomy is an established and low-risk intervention. If possible, he should nevertheless be carried out in a hospital with a pediatric surgery department.

The pyloric stenosis can also be treated conservatively (without surgery). However, this method is usually tedious. Here, the child is fed with small meals (about ten to twelve small meals per day) and stored to sleep with 40 degrees upper body. In addition, medications such as atropine (parasympatholytic) can be used to relax the pyloric muscles and reverse muscle hypertrophy. This treatment is recommended when surgical treatment is not possible for medical reasons.

Pyloric stenosis: disease course and prognosis

If the pyloric stenosis is treated surgically at an early stage, the prognosis is usually good even in severe cases. After an operation, the child can already be fed with milk after two to four hours. If the child vomits again, the meals should first be reduced in size and gradually increased. A pyloric stenosis usually does not occur again. Thanks to operational measures, the mortality rate is well below one percent today.

Complications of pyloric stenosis:

If the pyloric stenosis is not operated, there is danger to life because of the massive metabolic derailments (metabolic alkalosis and dehydration). With timely diagnosis and treatment, serious complications can be prevented. The children first receive infusions to stabilize the fluid and electrolyte balance. If her condition has stabilized, the pyloric stenosis be serviced.