Hypertrophic pyloric stenosis in infants

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Originally from https://resources.wfsahq.org/uia/vol-37-paediatrics-special-edition/ | Update in Anaesthesia

Maxwell Tobin* and Elizabeth T Drums

*Correspondence email: maxikoto@yahoo.co.uk

doi:10.1029/WFSA-D-20-00007

Dr Maxwell Tobin MBBS, DA (WASC), FWACS, PEAD ANAESTH CERT Association of Professional Women Engineers of Nigeria Port Harcourt Branch Port Harcourt  Rivers  NIGERIA

Dr Elizabeth T. Drum MD, FAAP, FCPP, FASA Associate Professor of Clinical Anesthesiology  and Critical Care Perelman School  of Medicine University of Pennsylvania USA

Abstract

Hypertrophic pyloric stenosis is a common condition, occurring in 1 out of 500 live births. Boys are affected more than girls, with a ratio of 4:1.  Presentation is usually between 2 – 6 weeks of life with classical non-bilious projectile vomiting. Examination will reveal a dehydrated child with a palpable olive-shaped mass located between the midline and right upper quadrant. The lesion is commonly delineated by ultrasonograpgy. The exact cause is largely unknown, however several theories have been advanced, which include genetic and environmental factors. It is not a surgical emergency, so the initial management is aimed at resuscitation that will correct dehydration, electrolyte and acid-base disturbances before proceeding to surgery. Rapid sequence intravenous induction, endotracheal intubation and muscle relaxation is the anaesthesia technique of choice. Post operative apnea is a possibility, and such monitoring should continue well into the postoperative period.

Key words:
hypertrophic; pylorus; stenosis; infants; anaesthesia