A baby boy, less than a month old, was brought to the hospital with severe vomiting. Despite having a strong appetite, he would regurgitate breast milk immediately after feeding. Over time, his vomiting became more forceful, resembling a fountain. Medical tests confirmed that the baby had hypertrophic pyloric stenosis.
Hypertrophic pyloric stenosis is a digestive disorder primarily affecting infants. It occurs when the pylorus—the muscle connecting the stomach to the small intestine—thickens abnormally, narrowing the passage. This obstruction prevents breast milk or formula from passing into the small intestine, resulting in stomach accumulation and vomiting.
Dr. Choi Yong Jae, President of the Korean Children’s Hospital Association and Director of Uijeongbu Tntn Child Hospital, explained that the pylorus functions as a sphincter between the stomach and small intestine. When it thickens and narrows, food cannot pass through, leading to stomach distension and pressure-induced vomiting.
Although the exact cause of this congenital condition remains unclear, experts believe genetic and environmental factors contribute to its development.
The primary symptom is repeated vomiting after feeding, which can progress to projectile vomiting. Notably, the vomit does not contain green bile. In severe cases, physical examination may reveal dehydration and a small, firm mass about the size of an acorn in the upper abdomen.
Dr. Oh Chae Youn, a pediatric surgeon at Korea University Ansan Hospital, said newborns often spit up after feeding, especially when eating too quickly. However, if vomiting becomes forceful and fountain-like, hypertrophic pyloric stenosis should be considered.
Experts note that symptoms typically appear around one month of age but can develop as early as two weeks. The condition is more common in male infants, firstborns, and those with a family history of the disorder.
The diagnosis is based on the vomiting pattern, weight loss, ultrasound examination, and blood tests. Ultrasound imaging confirms the diagnosis by measuring the thickness and length of the pyloric muscle and channel.
Dr. Choi emphasized that blood tests often reveal severe electrolyte imbalances. If left untreated, these imbalances can lead to seizures. Parents must seek immediate medical attention if symptoms appear.
Surgical intervention is the primary treatment. If dehydration or electrolyte imbalances occur, intravenous fluid therapy is administered first.
The procedure, known as laparoscopic pyloromyotomy, involves an incision in the thickened pyloric muscle to relieve the obstruction and allow food to pass from the stomach to the small intestine.
Dr. Choi reassured me that the surgery is relatively straightforward, low-risk, and has high recovery rates. However, as with any surgery, there is a slight risk of complications, such as wound infections or gastrointestinal bleeding.
Dr. Oh concluded that ultrasound allows for a quick and accurate diagnosis. Since the condition can be treated with simple surgery, early intervention is key to restoring the child’s health.
