Pyloric stenosis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

The symptoms of pyloric stenosis usually develop in the first days of life, and start with projectile vomiting. If left untreated, infants with mild infantile pyloric stenosis can develop severe electrolyte imbalances include hypokalemia , hypochloremia, and metabolic alkalosis.In rare cases of untreated pyloric stenosis, patients may develop significant problems on the cognition, receptive language, fine motor, and gross motor skills compared to the normal infants due to long term malnutrition. Complications of infantile pyloric stenosis before surgery include vomiting and failure to gain weight in newborn period. Prognosis is generally excellent and surgery usually provides complete relief of symptoms. Infants usually tolerate small, frequent feedings several hours after surgery

Natural History, Complications, and Prognosis

Natural History

The symptoms of pyloric stenosis usually develop in the first days of life, and start with projectile vomiting.
If left untreated, infants with mild infantile pyloric stenosis can develop severe electrolyte imbalances include hypokalemia , hypochloremia, and metabolic alkalosis.^[1]
In rare cases of untreated pyloric stenosis, patients may develop significant problems on the cognition, receptive language, fine motor, and gross motor skills compared to the normal infants due to long term malnutrition.^[2]

Complications

Complications of infantile pyloric stenosis before surgery include:^[1]

Complications of infantile pyloric stenosis after surgical correction include:^[3]^[4]^[5]
- Vomiting: This is a very common complication after surgical correction and generally improves over time.
- Failure to gain weight in newborn period.
- Common complications of the surgery are :
  - Bleeding
  - Infection

Prognosis

Prognosis is generally excellent and surgery usually provides complete relief of symptoms. Infants usually tolerate small, frequent feedings several hours after surgery.^[6]

Up to 80% of patients continue to regurgitate even after surgical correction.^[6]

References

↑ ^1.0 ^1.1 Tutay GJ, Capraro G, Spirko B, Garb J, Smithline H (2013). “Electrolyte profile of pediatric patients with hypertrophic pyloric stenosis”. Pediatr Emerg Care. 29 (4): 465–8. doi:10.1097/PEC.0b013e31828a3006. PMID 23528507.
↑ Walker K, Halliday R, Holland AJ, Karskens C, Badawi N (2010). “Early developmental outcome of infants with infantile hypertrophic pyloric stenosis”. J Pediatr Surg. 45 (12): 2369–72. doi:10.1016/j.jpedsurg.2010.08.035. PMID 21129547.
↑ Spitz L (1979). “Vomiting after pyloromyotomy for infantile hypertrophic pyloric stenosis”. Arch Dis Child. 54 (11): 886–9. PMC 1545582. PMID 526031.
↑ Srivastava NT, Parent JJ, Schamberger MS (2017). “Consideration of pyloric stenosis as a cause of feeding dysfunction in children with cyanotic heart disease”. Ann Pediatr Cardiol. 10 (3): 298–300. doi:10.4103/apc.APC_51_17. PMC 5594945. PMID 28928620.
↑ Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG; et al. (2017). “Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology”. World J Gastroenterol. 23 (8): 1328–1337. doi:10.3748/wjg.v23.i8.1328. PMC 5330817. PMID 28293079.
↑ ^6.0 ^6.1 Gibbs MK, Van Herrden JA, Lynn HB (1975). “Congenital hypertrophic pyloric stenosis. Surgical experience”. Mayo Clin Proc. 50 (6): 312–6. PMID 1127996.

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[pmid23528507-1] 1.0 ^1.1 Tutay GJ, Capraro G, Spirko B, Garb J, Smithline H (2013). “Electrolyte profile of pediatric patients with hypertrophic pyloric stenosis”. Pediatr Emerg Care. 29 (4): 465–8. doi:10.1097/PEC.0b013e31828a3006. PMID 23528507.

[pmid21129547-2] Walker K, Halliday R, Holland AJ, Karskens C, Badawi N (2010). “Early developmental outcome of infants with infantile hypertrophic pyloric stenosis”. J Pediatr Surg. 45 (12): 2369–72. doi:10.1016/j.jpedsurg.2010.08.035. PMID 21129547.

[pmid526031-3] Spitz L (1979). “Vomiting after pyloromyotomy for infantile hypertrophic pyloric stenosis”. Arch Dis Child. 54 (11): 886–9. PMC 1545582. PMID 526031.

[pmid28928620-4] Srivastava NT, Parent JJ, Schamberger MS (2017). “Consideration of pyloric stenosis as a cause of feeding dysfunction in children with cyanotic heart disease”. Ann Pediatr Cardiol. 10 (3): 298–300. doi:10.4103/apc.APC_51_17. PMC 5594945. PMID 28928620.

[pmid28293079-5] Romano C, Oliva S, Martellossi S, Miele E, Arrigo S, Graziani MG; et al. (2017). “Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology”. World J Gastroenterol. 23 (8): 1328–1337. doi:10.3748/wjg.v23.i8.1328. PMC 5330817. PMID 28293079.

[pmid1127996-6] 6.0 ^6.1 Gibbs MK, Van Herrden JA, Lynn HB (1975). “Congenital hypertrophic pyloric stenosis. Surgical experience”. Mayo Clin Proc. 50 (6): 312–6. PMID 1127996.

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