Hypertrophic pyloric stenosis (pyloromyotomy)

The pylorus is the muscle that closes the outlet of the stomach. In some infants, most often between 2 and 8 weeks of age, this muscle thickens and prevents milk from passing into the intestine: this is hypertrophic pyloric stenosis. It is more common in boys. The baby vomits after every breastfeed or bottle, more and more forcefully ("projectile" vomiting), while still being hungry. Without treatment, the baby loses weight and becomes dehydrated. The diagnosis is confirmed by an ultrasound scan, which measures the thickness of the muscle, and blood tests check the baby's hydration. Treatment is surgical: pyloromyotomy (the Fredet–Ramstedt procedure) consists of cutting the thickened muscle lengthwise without opening the inside of the digestive tract, which frees the passage. It is done through a small incision near the navel or by laparoscopy. Before the operation, the baby is first rehydrated through a drip and blood results are corrected: it is not an immediate surgical emergency. At Clinique Pasteur Tunis, the infant is cared for by a paediatric surgeon and an anaesthesia team used to caring for very young children. Feeding resumes quickly after the operation, together with the parents.