Pyloric stenosis is a narrowing of the opening between the stomach and the small intestine. This rare condition in infants can cause food to become trapped inside the stomach.
Normally, there is a ring-shaped muscle valve that functions to keep food in the stomach by closing or to allow food to flow into the small intestine by opening. In pyloric stenosis, the muscle tissue in this valve becomes enlarged. As a result, the passage narrows significantly, preventing most or sometimes all food from passing into the small intestine.
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Symptoms of Pyloric Stenosis in Infants
Symptoms usually appear when the baby is between 3–6 weeks old and are uncommon in babies older than 3 months.
Common signs include:
- Vomiting after feeding: Babies may vomit forcefully, ejecting breast milk or formula several feet away. This is known as projectile vomiting. Vomiting usually occurs immediately after feeding. At first, it may be mild but often worsens over time.
- Persistent hunger: Babies with pyloric stenosis often want to feed again shortly after vomiting.
- Stomach contractions: Ripple-like waves may be seen across the baby’s abdomen after feeding but before vomiting, showing the stomach muscles straining to push food out.
- Dehydration: Signs include infrequent urination (fewer wet diapers), lethargy, dry mouth and lips, and crying without tears.
- Changes in stool: Since food cannot pass into the intestines, constipation may occur.
- Weight loss: Limited nutrition intake may lead to poor weight gain or even weight loss.
Causes of Pyloric Stenosis
The exact cause of pyloric stenosis is unknown, but both genetic and environmental factors are believed to play a role. The condition typically develops after birth rather than being present at delivery.
Risk factors include:
- Male gender
- Firstborn child
- Premature birth
- Family history of pyloric stenosis
- Mother who smokes during pregnancy
- Exposure to certain antibiotics late in pregnancy or shortly after birth
- Formula feeding
Complications of Pyloric Stenosis
If left untreated, pyloric stenosis can cause complications such as:
- Failure to thrive – Insufficient nutrition affects growth, weight gain, and development.
- Dehydration – Repeated vomiting can lead to dehydration and electrolyte imbalance, which are crucial for vital body functions.
- Jaundice – In rare cases, a buildup of bilirubin in the body can cause yellowing of the skin and eyes.
Diagnosis of Pyloric Stenosis in Infants
A pediatrician will ask about the baby’s symptoms and perform a physical exam. In some cases, a small, olive-shaped lump can be felt in the baby’s abdomen, representing the enlarged pyloric muscle. Stomach contractions may also be visible during feeding.
Diagnostic tests include:
1. Imaging tests
- Ultrasound (USG): The primary diagnostic tool, showing enlargement of the pyloric valve.
- X-ray: A special contrast X-ray may provide video imaging of stomach activity, but it is less commonly used than ultrasound.
2. Blood tests
Bloodwork may reveal dehydration and electrolyte imbalance.
Treatment of Pyloric Stenosis in Infants
Treatment requires surgery. Before surgery, fluids and electrolytes are administered through an IV to stabilize the baby’s hydration and balance, usually over 24–48 hours.
The surgery, called pyloromyotomy, involves making an incision in the thickened pyloric muscle and spreading it apart to widen the passage, allowing food to pass from the stomach to the small intestine. The stomach lining bulges into the opened space, but no leakage occurs.
Laparoscopic surgery is most common, performed through three small incisions: one for a camera and two for surgical instruments. This method typically allows faster recovery.
In some cases, open surgery with a larger incision may be performed.
Post-surgery care includes:
- Close monitoring for at least 24 hours.
- Feeding usually resumes within 12–24 hours.
- The medical team may recommend feeding on demand or following a set schedule.
- Some babies may continue vomiting for a short period after surgery.
- Follow-up visits to track weight, growth, and development.
Possible complications after surgery include bleeding and infection, though these are rare. Overall, surgical outcomes are excellent.
Pediatric Surgeon at RS Mandaya Royal Puri: dr. Sastiono
RS Mandaya Royal Puri is home to dr. Sastiono, Sp.B Subsp.Ped(K), a highly respected pediatric surgeon specializing in complex and rare conditions in children, including pyloric stenosis.
dr. Sastiono completed his medical training at the Faculty of Medicine, Universitas Indonesia, continued through PPDS and PPDU programs, and achieved the title of Pediatric Surgery Consultant.
In addition to pediatric surgery, he has expertise in hepatobiliary surgery, involving procedures on the liver, gallbladder, bile ducts, and pancreas. He also has advanced experience in pediatric liver transplantation, a highly complex procedure.
Beyond pyloric stenosis, dr. Sastiono is skilled in treating other rare and challenging pediatric conditions such as:
- Biliary Atresia
- Anorectal Malformations (Atresia Ani)
- Hirschsprung Disease
- Pediatric Hernia
- Pediatric Appendicitis
- Liver Disorders in Children
- Pediatric Liver Transplantation
Clinic schedule at RS Mandaya Royal Puri:
- Tuesday: 10.00 – 13.00 WIB
- Thursday: 10.00 – 13.00 WIB
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