Vomiting in Babies: Pyloric Stenosis (Narrowed Stomach Outlet)

Every baby vomits sometimes after feeding. If a baby has pyloric stenosis, it is a stomach disorder. Gradually, the vomiting after feeding will become more and more forceful. This is due to the fact that the stomach port is too narrow, meaning that food cannot or hardly pass through. This condition almost only occurs in babies of a few weeks old. Fortunately, this condition can be easily remedied. How do you recognize this condition and what are the consequences for the child?

What it is

The pylorus is a sphincter and the lower opening of the stomach. This is also called the stomach porter. It is the transition from the stomach to the duodenum. If a narrowing occurs there, it is called pyloric stenosis. The medical name for a narrowing is stenosis. This stomach condition is almost only seen in babies of a few weeks old. If this sphincter becomes thicker, the stomach contents can no longer pass through and the food is forced out through the mouth due to the pressure in the stomach. This forceful vomiting, in which it comes out in an arc, is also called projectile vomiting.

Clinical picture

This condition affects approximately 3 in 1,000 babies and affects boys in 90% of cases. Pyloric stenosis is often not discovered until the child is about two to six weeks old. It is noticeable that the baby gradually vomits more and more after feeding. Sometimes it comes out immediately after feeding, but it can also take a few hours. There may be only a little vomiting at first, but it will get progressively worse and at some point the child will vomit violently after each feeding. The baby hardly gets any fluid and food, which causes the baby to quickly lose weight and dehydrate. The baby becomes drowsy, limp and the eyes lie deeper in their sockets. The baby won’t be in much pain, but he won’t feel well either. There is no fever and diarrhea.

Diagnosis

The doctor will first perform a general physical examination and feel the abdomen. The thickened pylorus can be felt from the outside through the abdominal wall as a lump the size of an olive. Through the abdominal wall you can see that the stomach is contracting. The diagnosis can be made with certainty by means of an ultrasound. An X-ray examination is then no longer necessary. This is usually a congenital condition. The stomach door does not open properly or at the right time. Once pyloric stenosis has been diagnosed, it will need to be corrected with surgery. Do not wait too long to consult a doctor if your baby vomits a lot, because a baby can quickly become dehydrated.

Operation

Although the operation itself is not a difficult procedure, it is still risky because it involves a small patient who may already have weakened considerably. However, it is important that the child is helped as quickly as possible. The condition of the baby plays a major role. During the operation, the thickened muscle is carefully split down to the mucous membrane. When the muscle relaxes again, there is enough space for the food to pass through again. The prospects after surgery are usually very good. The risk that a baby will die from pyloric stenosis is less than one percent. Nowadays, this procedure is performed, if possible, by means of keyhole surgery.

After the operation

It is important that the baby is fed again as soon as possible to replenish all deficiencies. Within six hours he will get some nutrition again. The amount is slowly being expanded. If everything goes well and the baby has regained sufficient strength, the child can usually go home two days after the procedure. The severed sphincter muscle no longer grows together, so the narrowing cannot return.

Acquired pyloric stenosis

In a rare number of cases, pyloric stenosis only develops later in life, sometimes only in adulthood. In adults, this condition is often mistaken for stomach cancer before the diagnosis has been made because it basically causes the same symptoms. It is not known why passage complaints only develop later in life. Presumably there is an abnormality from birth, but it only causes complaints at a later age. There is often reduced gastrointestinal passage due to a thicker sphincter muscle. If the narrowing does not cause any complaints, surgery is not required.