Hourglass symptom. Symptoms and treatment of pyloric stenosis in newborns. Due to constant vomiting in a child

Pyloric stenosis is a malformation of the gastrointestinal tract, in which an organic narrowing of the pyloric section of the stomach, connected by the duodenum, occurs. The manifestation of the disease is observed at 2–4 weeks of the baby’s life, when he begins to vomit “fountain” immediately after feeding, a decrease in body weight occurs, constipation, oliguria, and skin turgor appear. The disease is diagnosed using endoscopic, x-ray and ultrasound examination of the stomach. Pyloric stenosis can only be treated surgically.

Description of the disease

Pyloric stenosis is a defect, which is characterized by narrowing of the lumen of the pylorus - the outlet section of the stomach. Due to the narrow pylorus, food masses have difficulty penetrating the duodenum, leading to stagnation of food in the stomach. When it overflows, severe vomiting occurs. At first it brings relief, but after a while the stomach expands significantly, becomes inelastic, and food stagnation worsens.

A person, consuming a normal amount of food, constantly experiences hunger, because food masses do not go through the necessary stages of digestion and assimilation. This disease even prevents the movement of fluid, which is very dangerous due to the resulting exhaustion of the body and increasing dehydration.

The disease happens congenital or occurs as a result of secondary damage to the pylorus. Congenital pyloric stenosis manifests itself in childhood with severe symptoms and is more common in boys. Acquired pyloric stenosis usually develops as a consequence of a long-term course of a chronic ulcer, duodenal ulcer or stomach tumor, as well as as a result of pyloric spasm, chemical burns of the digestive tract.

Causes

Formation of congenital pyloric stenosis occurs long before the birth of the child, at the beginning of the third month of gestation. The walls of the pylorus begin to thicken, their elasticity gradually disappears, and the lumen narrows. As a result, the pylorus begins to resemble a deformed tube that cannot fully contract. Thickening of the walls occurs mainly due to a layer of muscles consisting of smooth muscle bundles that increase in size. After some time, connective tissue grows between them, and scarring may even form.

It has been proven that with pyloric stenosis, not only tissue hypertrophy occurs, but also innervation is disrupted, which aggravates the anatomical changes of the pylorus. It has not yet been established why the walls of this part of the stomach undergo such changes, but some scientists believe that the cause is intrauterine infection.

Also, the causes of the development of congenital pyloric stenosis include hereditary predisposition. If one of the parents was diagnosed with such a diagnosis in childhood, then the likelihood of its detection in the child increases several times.

Acquired pyloric stenosis develops due to alkaline and acid burns, which damage the muscle layer and mucosa with the formation of scar tissue.

Symptoms

Symptoms of congenital pyloric stenosis develop in the first weeks of a child's life. The baby begins to spit up and may even vomit. Pronounced signs of the disease appear at 2–3 weeks of a newborn’s life. The main symptom of pyloric stenosis is profuse vomiting after each feeding. The volume of vomit in this case exceeds the amount of milk consumed during the last feeding several times. Vomit resembles the appearance of curdled milk, which has a sour odor. At the same time, they do not contain bile impurities, which is an important sign of congenital pyloric stenosis.

Due to constant vomiting in a child:

malnutrition and dehydration begin to rapidly progress;
constipation appears;
the frequency of urination decreases.

The baby's stool turns dark green due to the large amount of bile. The urine becomes concentrated, and colored stains remain on the diapers. The “hourglass” symptom develops when, upon examination, peristalsis and two rounded protrusions with a narrowing between them are clearly visible.

Since the water-salt balance is disturbed, severe metabolic and electrolyte disturbances develop, the blood thickens, and deficiency anemia occurs. Congenital pyloric stenosis can be complicated by gastric bleeding. Often, vomit is thrown into the respiratory tract, causing the development of aspiration pneumonia.

Diagnostics

If there is a suspicion that the child has developed symptoms of congenital pyloric stenosis, the pediatrician will refer him to a pediatric surgeon. To confirm diagnosis, conduct X-ray, endoscopic and ultrasound examination of the stomach.

The doctor, examining the child, determines swelling in the epigastric region and visible contours of gastric peristalsis (hourglass syndrome). Quite often it is possible to palpate the pylorus, which has a plum-like shape and a dense consistency.

Diagnosis of the disease involves laboratory tests:

biochemical blood test;
Blood CBS;

Blood tests show decreased ESR and increased hemoglobin. Diagnosis requires mandatory ultrasound and gastroduodenoscopy. An x-ray is taken using a contrast agent (barium). The image clearly shows the narrowed section of the pylorus, and dense cords are visible at the muscle sites.

Treatment

Treatment of pyloric stenosis in children It is carried out mainly surgically. The type of operation is chosen taking into account various factors:

general condition of the child;
deviations from the norm in laboratory test results;
degree of tissue dehydration;
presence of individual characteristics.

Treatment with surgery provides special training. Over the course of several days, the child is given drips with glucose-salt and protein solutions, which leads to the restoration of the body’s water balance. At the same time, the child receives all the necessary nutrients.

After preparation, the baby undergoes surgery. In children, a Frede-Ramstedt pylorotomy is usually performed. This is an operation that allows you to preserve the integrity of the digestive tract to the maximum. During surgery, the surgeon dissects the serosa, a thickened muscle layer. The mucous membrane is not affected; sutures are not applied to the crossed muscular and serous layers.

By opening the tight ring located around the outlet of the stomach, the pressure on the mucous membrane is reduced. As a result of this, it straightens, forming a normal diameter of the pyloric lumen and ultimately eliminating pyloric stenosis.

If the child's condition is serious, then this is not a contraindication to surgery, since otherwise the disease is fatal. After surgery, the baby is left in the hospital until his condition improves. A rehabilitation course is carried out, during which the amount of food consumed is increased in small portions.

First, the child is given two spoons of saline and the peristalsis of the stomach is monitored. If it is within normal limits, then the baby is fed expressed breast milk in a volume of 20 - 25 ml. Feedings should be done frequently, up to 10 times a day, gradually increasing the amount of milk. After a week, the portion is adjusted to normal nutritional loads.

Forecast

Pyloric stenosis after surgical treatment ends with recovery, the development of children proceeds without deviations from the norm, no disturbances from the gastrointestinal tract occur. After the operation, the child may vomit, but such cases are rare and go away on their own.

Pyloric stenosis in children, if untimely diagnosis and untimely treatment, can result in the death of the child due to severe dehydration and its complications. If the disease is diagnosed on time and followed by surgical treatment, a favorable outcome is guaranteed.

Thus, pyloric stenosis in newborns, the symptoms, diagnosis and treatment of which have been discussed, is a very serious disease. Its main symptom is profuse vomiting, which quickly leads to dehydration of the body, which is very dangerous for health. That is why it is very important to treat pyloric stenosis in a timely manner.

Pyloric stenosis in newborns is a congenital malformation of the pyloric region (in medicine it is called “pyloric”) of the stomach, which occurs under the influence of genetic factors and provokes vomiting in children.

The disease occurs in 1-3 children per 1000, and boys, according to various sources, suffer 5-7 times more often than girls. What is the pathology expressed in? First, let's remember the main functions of the gatekeeper zone.

The pylorus is the last section of the stomach. Its muscle, known as the sphincter, regulates the movement of semi-digested food (chyme), passing it in portions into the duodenum and further into the intestines. In addition, the sphincter will only allow sufficiently digested food to pass through, one that will not cause harm to the mucous membrane of the small intestine.

If there are no pathologies, the contents from the stomach move only in one direction: from top to bottom. However, a sharp narrowing of the lumen of the pyloric canal (stenosis) leads to constant vomiting and metabolic disorders. How pronounced the clinical symptoms will be depends on the degree of narrowing and the compensatory abilities of the body.

Reasons for development

To date, the causes of the development of the disease have been little studied. The fact that it is innate suggests that the influence is exerted by:

Hereditary predisposition. If one of the parents was diagnosed with pyloric stenosis in childhood, the likelihood of detecting it in the child increases significantly.
Intrauterine pathologies: toxicosis of a pregnant woman; transmission of viral infections by the mother during pregnancy; disruptions in the functioning of the mother’s endocrine system; taking medications.

What is the danger

First of all, due to a decrease in contractility, food is not able to be evacuated normally, and the stomach itself is stretched. The contents need to go somewhere, so frequent vomiting occurs, and as symptoms increase, they literally gush out.

Narrowing of the pylorus disrupts the normal functioning of the digestive tract and is life-threatening. In the central photo below you can see the “hourglass” symptom, when the stomach protrudes in the form of two tubercles

Along with vomit, fluid loss occurs, as a result of which the water-electrolyte balance is disrupted, the blood thickens, and the body lacks vitamins and microelements. All children experience alkalosis (a shift in blood pH towards alkalization). The disease, left to its own devices, is fatal.

Symptoms

The disease goes through three stages, each of which has its own symptoms, or they simply get worse.

Compensation stage

At this stage there are no clinical signs of the disease. There is a feeling of heaviness and nausea, but the baby cannot talk about it yet. The onset of vomiting brings temporary relief. The x-ray shows active peristalsis, the pyloric canal is narrowed, and the stomach is enlarged in size. Food from the stomach moves slowly, with a delay of 6-10 hours.

Subcompensation stage

Vomiting occurs every day, bringing relief. Abdominal pain is paroxysmal, with a feeling of colic. Belching smells like rotten eggs. Against the background of daily vomiting, body weight sharply decreases. The child is lethargic and weak. Peristalsis during examination of the abdomen is clearly visible.

Decompensation stage

Vomiting is profuse, gushing, containing fragments of undigested food. Pain and distension in the epigastric region. There are signs of dehydration: dry skin, decreased turgor, dry mouth. The contours of the stomach, which has increased in size, are clearly visible through the abdominal wall. Peristalsis is very weak, so chyme is evacuated with a delay of up to 2 days or more. Blood pressure is reduced, the skin is pale, and the amount of urine output is reduced.

Fountain vomiting after feeding is a high alarm signal, meaning that you need to seek medical help urgently if, for some reason, you have not already done so

So, the main symptoms of pyloric stenosis in a newborn are as follows:

vomiting of an increasing nature after 20 minutes after eating;
the amount of vomit exceeds the amount eaten; the smell is unpleasant, but there is no bile;
very little stool, dark in color; this is explained by the minimal content of dairy products and the presence of bile;
urination is rare and small in volume. The consistency is cloudy, concentrated;
“hourglass” symptom - when examining the abdomen, peristalsis and two rounded protrusions with a narrowing between them are clearly visible;
“hungry” facial expression with pointed shapes.

Diagnostics

The final diagnosis is made after collecting anamnesis (when the symptoms are pronounced), examination and palpation of the abdomen, as well as the use of instrumental and laboratory research methods.

Examination of the abdomen reveals an expansion of the epigastric region, which is clearly visualized against the background of the sunken lower parts of the digestive tract. Sometimes you can even palpate the pylorus. On the baby's tummy you can see the contours of an enlarged stomach and peristalsis. Blood tests show elevated hemoglobin levels and decreased ESR.

Diagnosis necessarily includes gastroduodenoscopy and ultrasound. An x-ray is taken with a contrast agent (barium). The image shows a narrowed section of the pylorus; dense cords can be seen in place of the muscles.

There are a number of diseases accompanied by vomiting in infancy, therefore, upon admission to the hospital, differential diagnosis is carried out for pylorospasm, purulent meningitis, intracranial trauma during childbirth, chalasia and achalasia of the esophagus, diaphragmatic hernia, cancerous stenosis and other diseases.

What is pylorospasm?

Pylorospasm is a contraction of the pyloric part of the stomach due to a violation of its innervation. He also needs treatment, but only conservatively. How can it be distinguished from pyloric stenosis?

Treatment

The earlier the correct diagnosis is made, the sooner treatment can begin: in this case we are talking about surgical intervention. The operation is urgent, but still requires preparation. Therefore, it is usually carried out 2-3 days after diagnosis.

Preoperative preparation includes restoring water and electrolyte balance and replenishing micronutrient deficiencies. To do this, the child is infused with various solutions. If there are concomitant inflammatory diseases, treatment with antibacterial drugs is prescribed.

The main task of surgeons is to restore the lumen of the pylorus, but at the same time keep the stomach intact

Pylorotomy (the so-called operation when the pylorus is dissected) is performed according to the Frede-Ramstedt method. As the anatomical obstacle to the evacuation of chyme is eliminated, the patency of the pyloric canal returns to normal. Feeding with breast milk (or formula) in the postoperative period is dosed. That is, the baby is fed often, but in small portions. If everything went well, little patients are discharged home for 8-9 days.

Possible complications

If the child was brought in in a “neglected” state, the following complications may develop:

aspiration pneumonia - entry of vomit into the organs of the respiratory system and the development of inflammation;
ulceration of the gastric mucosa;
imbalance of electrolyte blood composition along with dehydration;
sepsis (blood poisoning), leading to death.

Forecasts for the future

After timely and correct treatment, the prognosis is favorable. The gastrointestinal tract is functioning normally, and the baby feels well. The child is periodically observed by a gastroenterologist to make sure everything is in order.

As you can see, treatment of pyloric stenosis in a newborn cannot be delayed. If your baby continues to vomit daily in the first 3-4 weeks after birth, be sure to consult a doctor. Timely provision of assistance is the key to the health of your baby.

Pyloric stenosis (syn. pyloric stenosis) in children is a congenital pathology, but can sometimes develop in adults. Gastroenterologists note that such a disease is one of the most common anomalies in the development of the stomach, which occurs in pediatrics and requires immediate medical intervention. A characteristic feature is that this disorder is several times more common in boys than in girls. The disease has its own meaning in the international classification of diseases. The ICD-10 code is Q40.0.

The disease has several specific symptoms, among which it is worth noting the so-called “hourglass” syndrome and profuse vomiting immediately after feeding.

In most cases, this disorder is diagnosed in the first month of a baby’s life using instrumental diagnostic examinations. Pyloric stenosis in newborns can only be treated with surgery.

Etiology

The pyloric region of the stomach, or pylorus, is the distal part of this organ, which is adjacent to the duodenum and includes the antrum (the terminal part of the pyloric region) and the pyloric canal. This part of the stomach acts as a reservoir in which partially undigested food accumulates, from where the contents are transported to the duodenum. With congenital pyloric stenosis, the process of food passing through the pylorus is significantly hampered, which causes its accumulation in the stomach and the manifestation of the clinical picture of such a disease.

This disorder is quite common in pediatrics, as it occurs approximately once in three hundred newborns. However, the main reasons for its formation are not fully understood. However, several predisposing factors for the onset of the disease in infants have been identified. These include:

burdened heredity. Clinicians have noted that the presence of such a pathology in one of the parents increases the chances of its development in the child a hundred times;
use of antibiotics in the first two weeks of a baby’s life;
unfavorable course of pregnancy, which may be complicated by severe toxicosis or dangerous conditions such as eclampsia or preeclampsia;
illnesses of an infectious or viral nature suffered early in pregnancy;
the presence of endocrine disorders in the mother;
indiscriminate use of medications during pregnancy;
intrauterine infections, such as rubella, herpes or cytomegalovirus;
high level of gastrin in the female body;
influence on the body of unfavorable living conditions, chemicals or radiation.

Pyloric stenosis in adults is an acquired disorder, or rather secondary. Often develops against the background of:

peptic ulcers in the stomach, which are located quite close to the pylorus;
oncological process in the duodenum;
stomach cancer;
Crohn's disease;
inflammation of the appendix and other diseases of the digestive system;
pathologies of the bile ducts;
formation of the adhesive process.

In this case, the process of narrowing of the pylorus occurs due to scar tissue or malignant neoplasm. Against the background of such a disease, the pyloric part of the stomach is almost completely replaced by dense and poorly extensible connective tissue, and the outlet of this organ narrows significantly, in some cases down to a microscopically thin opening.

This is what leads to the appearance of symptoms in adults, similar to the clinical picture of pyloric stenosis in non-congenital patients.

Classification

In gastroenterology there is only one classification of such a disorder - according to the degree of the pathological process. Thus, there are several forms of the disease:

compensated – characterized by minor symptoms;
subcompensated – characterized by a worsening of the patient’s condition and a more pronounced expression of symptoms compared to the previous stage;
uncompensated – severe exhaustion and signs of dehydration are observed.

Symptoms

Since the disease occurs in both adults and children, the clinical picture will differ slightly depending on the age category.

Symptoms of pyloric stenosis in adults:

constant heaviness and discomfort in the stomach;
attacks of nausea and vomiting immediately after meals. It is worth noting that gagging significantly improves a person’s condition;
severe pain syndrome, which is bursting in nature;
belching with an unpleasant odor of recently consumed foods;
weight loss;
aversion to food, which is caused by the manifestation of the above manifestations;
signs of vitamin and mineral deficiency.

In children, congenital hypertrophic pyloric stenosis will be expressed by the following symptoms:

vomiting “fountain” immediately after feeding. In this case, exactly the same or more milk and liquid may be released compared to the volume that was eaten. Vomiting constantly intensifies and has a sour smell, but does not have bile impurities;
“hourglass” syndrome - detected during examination and characterized by a distinct peristalsis and two rounded protrusions with narrowing;
a decrease in the baby’s body weight, which occurs against the background of profuse vomiting;
signs of dehydration;
darkening of stool;
decreased frequency of urination;
cloudy urine;
bowel dysfunction, which results in constipation;
drowsiness;
retraction of the fontanel;
loss of skin elasticity.

Similar symptoms of this disease begin to appear between the second and fourth weeks of a child’s life. If symptoms are ignored, especially specific vomiting, it can lead to coma or death of the patient. This is due to the fact that a newborn baby will not be able to live for a long time without food.

Diagnostics

Establishing the correct diagnosis is complex, but instrumental examinations have the greatest diagnostic value. Before their appointment, diagnostics goes through several stages.

Primary diagnosis is aimed at:

conducting a survey of the patient or his parents;
studying the patient’s medical history and life history;
performing a thorough physical examination, which must include palpation of the anterior wall of the abdominal cavity to identify specific signs of the disease.

Such events will allow the gastroenterologist to find out some of the reasons for the formation of the disease, as well as determine the stage of its progression.

Laboratory tests are aimed at general and biochemical examination of blood, urine, as well as microscopic examination of feces.

Instrumental methods include:

Ultrasound is the most common and effective method necessary to detect such a disease. During the procedure, there is a thickening of the pylorus and an increase in its volume, namely, thickness - by four millimeters, length - by about one and a half centimeters;
FEGDS is an endoscopic procedure for studying the inner surface of the esophagus, stomach and duodenum. Carried out when the previous examination is uninformative;
radiography of the affected organ - used in rare cases.

Such activities help the clinician not only make the correct diagnosis, but also carry out a differential diagnosis of such a disorder with such ailments as:

GERD;
hiatal hernia;
intestinal obstruction;
atresia or stenosis of the duodenum;
pylorospasm. Pyloric stenosis and pylorospasm are two very similar conditions characterized by narrowing of the pylorus of the stomach. The difference is that in the first case, the pathology is caused by excessive muscle growth, and in the second, the narrowing is caused by tension and contraction of the muscles of this organ. Both conditions are reversible, but only pylorospasm does not require surgical intervention.

Treatment

The only way to eliminate pyloric stenosis in children and adults is surgery. However, surgical treatment requires patient preparation, which is aimed at replenishing fluid deficiency and consists of:

administration of glucose-saline solutions;
symptomatic treatment with medications;
blood or plasma transfusions.

For pyloric stenosis, pyloromyotomy is performed, which involves:

dissection of hypertrophied muscles;
restoration of patency of the pyloric canal.

The operation is performed in several ways - transumbilical or laparotomy.

Postoperative recovery consists of dosed feeding of the baby. Often, surgical intervention allows the patient to completely get rid of the symptoms of the disease.

Complications

In cases where the clinical manifestations of the disease are ignored or treatment is not started in a timely manner, there is a possibility of severe consequences developing. These include:

pyloric ulcer;
hemorrhages in the gastrointestinal tract;
anemia;
sepsis;
delay in the development and growth of the child.

In addition, against the background of profuse and persistent vomiting, the following may appear:

aspiration pneumonia;
otitis;
asphyxia;
dehydration;
coma.

A process such as aspiration of vomit can be fatal.

Prevention

There are no specific preventive measures for congenital pyloric stenosis. However, there are several recommendations that women should follow during pregnancy:

lead a healthy lifestyle;
eat properly and balanced;
avoid stress;
take medications only as prescribed by a doctor;
register in a timely manner and do not miss a visit to the obstetrician-gynecologist.

The only measure to prevent such a disease in adults is the elimination of those diseases that can lead to the appearance of pylorospasm. To do this, you need to be examined by a gastroenterologist several times a year.

The prognosis of pyloric stenosis in children is often favorable, in adults it completely depends on what was the source of such pathology.

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Pyloric stenosis in children is a congenital narrowing of the pylorus; in rare cases, it can be acquired (scar narrowing due to a chemical burn or).

The disease is more common in boys. The main symptom is, which appears in the 2-3rd week of life. Vomiting is profuse, “fountain”; the amount of vomit, as a rule, exceeds the amount of milk taken by the child during feeding. There is no bile admixture in the vomit. At the onset of the disease, vomiting occurs within 10-15 minutes. after feeding, but subsequently as the stomach expands, the intervals between feeding and vomiting lengthen. Due to persistent vomiting, exhaustion and dehydration develop. The weight of a child of 1.5-2 months is often less than at birth. The number of urinations and the amount of urine with pyloric stenosis decreases, and constipation is more common. When examining the abdomen, in most cases one can observe gastric peristalsis in the form of an “hourglass” (Fig. 2). This symptom is very important and can be caused by stroking the skin of the abdomen in the stomach area. You can also speed up the appearance of peristalsis by giving your child a few sips of water. In doubtful cases, they resort to x-ray examination of the stomach. Laboratory tests reveal an increase in hemoglobin content and a slowdown (due to dehydration and blood thickening), as well as a decrease in the amount of chlorides in the blood due to loss with vomit.

Rice. 2. “Hourglass” symptom with pyloric stenosis in a 2-month-old child

Rice. 3. Pylorotomy according to Frede-Ramstedt: on the left - an incision in the serous-muscular layer (the edges of the incision are moved apart); on the right is the incision site.

Differential diagnosis should mainly be carried out with (see). Certain difficulties in differential diagnosis are presented by pseudopyloric stenosis, a disease based on endocrine disorders (see).

Treatment of pyloric stenosis is only surgical. The operation is indicated as soon as the diagnosis is made and consists of laparotomy and dissection of the muscular layer of the pylorus to the mucous membrane (Fig. 3). Feeding begins 3 hours after surgery with expressed breast milk, 10-20 ml every 2 hours. In subsequent days, add 10 ml for each feeding. Breastfeeding begins on the 4th day, but the main feeding continues with expressed breast milk. Breastfeeding is transferred from the 7th to 10th day. In severe cases of pyloric stenosis, in the first days after surgery, intravenous administration of a 5% glucose solution, isotonic sodium chloride solution, as well as repeated or plasma injections is necessary. After the operation, children develop normally.

Pyloric stenosis in children (pylorostenosis; from the Greek pyloros - pylorus and stenosis - narrowing) is a disease of children in the first months of life, which has a clinical picture of partial gastric obstruction.

The etiology and pathogenesis of the disease have not yet been sufficiently studied. Pyloric stenosis is based on a congenital malformation of the pyloric wall and a secondary nerve spasm.

Rice. 1. Longitudinal incision through the pylorus for pyloric stenosis (according to Ladd and Gross): 1 - “spur” formed by protrusion of the pylorus into the lumen of the duodenum; 2 - pocket of the mucous membrane.

Pathological anatomy. With pyloric stenosis, the pylorus of the stomach is sharply thickened, enlarged in size, and has a characteristic olive-like appearance of a whitish color and cartilaginous consistency. The pyloric lumen is sharply narrowed, and it is difficult for a button-shaped probe to pass through (Fig. 1). Microscopic examination reveals thickening of all layers of the pyloric wall (muscular, mucous, submucosal), excessive development of connective tissue, large size of muscle fibers and their nuclei, significant changes in the nerve plexuses and ganglion cells of the pyloric wall.

The clinical picture of a pronounced form of pyloric stenosis is characteristic. A child born at term, with a good weight, from the 2-4th week of life begins to vomit “fountain” after almost every feeding. Vomit that does not contain bile is ejected with great force in the form of a far-flying jet. In some cases, vomiting is preceded by regurgitation. Gradually, vomiting becomes less frequent, but more profuse. Vomit has a sharp, sour smell. There is retention of stool, sometimes independent scanty stool of a greenish color, reminiscent of meconium (“hungry” stool). The child urinates rarely (5 or even 2-3 times a day), in small portions. The weight is falling quickly. The skin becomes flabby, dry, loses turgor, and hangs in folds on the limbs (Fig. 2). Pronounced peristalsis of the stomach is clearly visible through the thin coverings of the abdominal wall. Blood is characterized by relatively high levels of hemoglobin and red blood cells, low levels of ROE (up to 1 - 3 mm per hour), which indicates blood thickening as a result of dehydration. Biochemical blood tests reveal an increase in reserve alkalinity of the blood, a decrease in the amount of chlorides, hypokalemia, signs of which are revealed on the ECG in the form of lengthening, flattening, and sometimes deformation of the T wave. Hypochloremic coma (yawning, shallow breathing, muscle hypotension, drowsiness, confusion) is rarely observed .

The diagnosis of severe forms is not difficult. There are, however, forms where diagnosis is difficult and requires great observation and thoroughness in collecting anamnesis.

To clarify the diagnosis, an X-ray examination of the stomach with barium is used (2 teaspoons of barium in 50-60 ml of expressed breast milk). The X-ray diagnosis of pyloric stenosis in the early stages of the disease is made on the basis of deep segmenting peristalsis of the stomach and the absence of the onset of gastric emptying in the first 15-20 minutes. after taking barium, keep the remaining barium in the stomach for up to 24 hours. In later stages of the disease, these symptoms are accompanied by expansion of the stomach.

In the differential diagnosis of pyloric stenosis, pylorospasm is of greatest practical importance - a disease similar in clinical picture to pyloric stenosis, but having a purely neurogenic origin and amenable to conservative treatment. With pylorospasm, vomiting begins from the moment of birth, is less profuse, inconsistent from day to day, and an admixture of bile is found in the vomit. Weight loss, defecation and urination problems are less pronounced or even absent. Visible gastric peristalsis is rare.

The prognosis of pyloric stenosis with timely and correct treatment is usually quite favorable. In the absence of timely treatment, children die by 4-5 months. life from exhaustion and secondary complications (pneumonia, etc.).

Treatment. The only correct method of treating pyloric stenosis at present should be considered surgical. The operation is performed within 1-3 days after the diagnosis is established. Too much exhaustion of a child should not be a contraindication for surgery, since without it these children are doomed to death. In severely malnourished patients, preparation for surgery is a prerequisite, which consists mainly of restoring water and salt metabolism. Within 2-4 days, the child should receive 2-4 blood or plasma transfusions in the amount of 10 ml per 1 kg of body weight; Ringer's solutions, physiological and 5% glucose solutions are administered intravenously, subcutaneously and in enemas. The child should receive at least 500-600 ml of liquid per day. If there are concomitant diseases (pneumonia, otitis), antibiotics are prescribed. On the eve of the operation, the child is given a blood transfusion, a general bath, and from 12 o'clock at night he is not fed or given water. With this feeding system, gastric lavage is not required before surgery.

The least dangerous method of pain relief is local anesthesia with a 0.25% novocaine solution. The best approach to the stomach and pylorus is through a midline incision from the xiphoid process of the sternum, 4-5 cm long. With a correctly made incision, the liver prevents intestinal eventration.

Pylorotomy (operation of dissection of the pylorus) according to the Frede-Ramstedt method (extramucosal pyloroplasty) consists of longitudinal dissection of the seromuscular layer of the pylorus along an avascular line (Fig. 3). The mucous membrane is not opened. After the incision, the edges of the pyloric wound are pulled apart with tweezers until the mucous membrane is completely released and bulges into the pyloric wound. Bleeding is usually minor. If there is a heavily bleeding vessel, prick it with catgut on a round needle and bandage it. The edges of the pyloric wound are not sutured. The integrity of the mucous membrane should be checked by squeezing the stomach contents towards the duodenum. If the mucous membrane is wounded, it is sutured with catgut. Interrupted catgut sutures with the addition of 2-3 silk are applied to the peritoneum along with the aponeurosis. The skin is sutured with a continuous entwining catgut suture, which promotes better hemostasis.

After the operation, a blood transfusion is performed. 2 hours after the operation, the child receives 10 ml of a 5% glucose solution, and after another 1 hour (3 hours after the operation), feeding with expressed breast milk begins every 2 hours with a 6-hour night break. The dosage of milk per single feeding on the first day is 20-30 ml; in case of injury to the mucous membrane or vomiting, the amount of milk is reduced to 5-10 ml. With each subsequent day, the daily dosage of milk increases by 100 ml. From the 5th-6th day, if the child does not vomit, 2 times for 5 minutes. applied to the breast, and from the 7th day transferred to breastfeeding after 3 hours. In the postoperative period, it is necessary to combat dehydration, exhaustion and impaired salt metabolism. All clinical and radiological symptoms of pyloric stenosis disappear within a short time after surgery. The long-term results of surgical treatment are good: children develop correctly and have no disturbances in the functioning of the gastrointestinal tract.

Narrowing of the pylorus is called pyloric stenosis. Every fifth baby out of 1000 children born is susceptible to this disease, with boys getting sick 4 times more often than girls. The disease is congenital in nature and acquired pyloric stenosis practically does not occur in children and newborns. How not to miss the manifestations of a dangerous disease, which doctor should you contact and what should you do to cure your child?

Types of pyloric stenosis

The pylorus is a small section located at the bottom of the stomach and connects it to the small intestine. If the pyloric canal is severely narrowed, then food cannot enter the duodenum. The narrowing occurs due to thickening of the pyloric muscle fibers.

There are two types of stenosis:

congenital – babies are born with a narrow pyloric canal;
acquired - develops due to a chemical burn, as a consequence of an operation or an infection.

Almost always, congenital pyloric stenosis occurs in children, not acquired.

Causes of stenosis

The reasons for the narrowing of the pyloric canal have not been fully identified. Experts identify 2 factors that can influence the thickening of the pylorus:

Heredity - relatives of 7% of children born with pyloric stenosis had the same disease.
Unfavorable pregnancy - infectious diseases, severe toxicosis in the early stages, disruptions in the endocrine system of the expectant mother.

Thickening of the walls of the pylorus is a malformation of the intrauterine development of the stomach, which forms in the 6th week of pregnancy.

Manifestations of the disease

If a child has a congenital narrowing of the pylorus, then it can be recognized already in the 2nd week of the baby’s life.

The main manifestation of the disease is profuse vomiting 15-25 minutes after each feeding. The entire volume of milk drunk is expelled from the child’s stomach, and this happens with such force that the range of ejection of vomit can reach 1 meter.

The milk looks a little overcooked, you can feel a sour smell, but there is no admixture of bile.

Since the child does not receive the necessary nutrition, he begins to experience other symptoms:

weight loss - at 1.5 months the child’s weight becomes lower than at birth, and at the age of 2 months the loss can be up to 30%;
constipation;
dehydration – newborns urinate no more than 6 times a day, urine becomes concentrated, the tongue becomes dry, and skin elasticity decreases;
the parietal fontanel is retracted;
the baby rarely smiles and has a “hungry and senile” expression on his face.

A distinctive feature of pyloric stenosis is visible gastric peristalsis. After feeding, stroking with your hand or a couple of sips of water, you can see a wave coming from the left hypochondrium to the right lower abdomen.

Stages of pyloric stenosis

Despite the fact that the disease develops rapidly, in infants there are 3 stages of the disease:

Light – weight loss reaches 0.1% of the child’s weight daily.
Average - the child loses weight up to 0.3% per day.
Severe – daily weight loss reaches 0.4% or more.

Over time, the child's stomach grows and stretches, vomiting becomes less frequent, but the volume of vomit increases.

How is the diagnosis confirmed?

If you notice symptoms of pyloric spasm in a child, you should immediately contact your pediatrician. The disease has clear symptoms and its diagnosis is not difficult.

The final diagnosis is made by a pediatric surgeon using:

information about the manifestation of the disease from the words of parents;
examination of the child with palpation of the abdomen;
food test - the doctor assesses the child’s condition immediately after feeding;
blood test - an increase in hemoglobin is noted, the ESR decreases, a deficiency of chlorine, sodium, and potassium is detected;
Ultrasound; if there is insufficient information obtained, an FGDS is performed; in exceptional cases, an X-ray with a dye is taken.

During diagnostic measures, the doctor excludes the development of another disease of the pylorus, which is called pylorospasm and has partially similar symptoms.

How to treat pyloric stenosis

There is no drug treatment for the disease. The only way to save the baby's life is surgery. Such surgical interventions have been carried out since 1922 and are now very well developed. The intervention is performed by a pediatric surgeon with the obligatory presence of a pediatric anesthesiologist.

Preparing for surgery

In case of severe exhaustion and dehydration, the child is given a blood transfusion for 2-4 days, fluids are administered subcutaneously, and glucose and electrolyte solutions are administered intravenously. The night before the operation, the baby is not allowed to eat or drink, so as not to provoke vomiting. Preparation is limited to a shared bathroom.

If there are still doubts about the diagnosis, the child is given atropine for several days to exclude pylorospasm.

Carrying out the operation

Only local anesthesia is used. At the discretion of the doctor, the method of performing pyloromyotomy is chosen - excision of the compacted muscles of the pylorus:

open surgery;
penetration through the navel;
laparoscopy.

Only surgical treatment can relieve the pressure of the pyloric muscles, expand the pyloric canal and restore communication between the stomach and the small intestine.

Postoperative period

Strict bed rest is prescribed. There are two factors that influence a child’s successful recovery after surgery:

Care - the wound is carefully monitored and if purulent discharge, redness, swelling is detected or the baby’s temperature rises, you should immediately consult a doctor.
Proper feeding - the first feeding with expressed milk after surgery is carried out after 3 hours in the amount of 30 ml, then every 2 hours with a mandatory night break. On the 4th day the baby is given breastfeeding twice. Starting from the 7th day after the operation, the baby is completely transferred to breastfeeding.

Prevention and complications

There are no special measures that will protect the child from narrowing of the pylorus. The only recommendation is to plan pregnancy and exclude all unfavorable factors from a woman’s life during this period.

During the course of the disease, the child may experience complications if the parents consult a doctor late:

exhaustion;
dehydration and blood disorders;
development of infections;
damage to the gastric mucosa.

The most dangerous consequences of pyloric stenosis are the death of a child from exhaustion, which can happen by the 4th month of life, or death as a result of vomit entering the respiratory tract, which can happen at any time.

Pyloric stenosis in infants is a rapidly developing congenital disease, the only treatment for which is surgery. At the first signs of illness - persistent vomiting and visible stomach peristalsis - you need to contact a pediatrician and undergo the required tests to make a diagnosis. The life of a child and pyloric stenosis are incompatible.