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Introduction Infantile hypertrophic pyloric stenosis (HPS) is a condition where hypertrophy of the pyloric sphincter results in narrowing of the pyloric canal. It is the most common cause of gastric outlet obstruction in the 2- to 12-week-old age group. Pyloric stenosis leads to progressive and projectile vomiting. It affects 2–3 per 1000 infants in Northern Europe but less common elsewhere in the world. Males (especially first borns) are affected approximately 4–6 times as often as females. The offspring of a mother, and, to a lesser extend the father who had pyloric stenosis are at higher risk for pyloric stenosis (Nelson Textbook of Paediatrcis, 20 th ed, Elsevier Saunders, 2016). Impetus To stimulate discussion and further research on extreme electrolyte imbalances babies can tolerate. To demonstrate importance of slow correction of electrolyte imbalance over 72 hours. To consider Pyloric Stenosis as one of the differential diagnosis for constipation in early infancy. Case Report We present a 9-week baby boy presenting with constipation and worsening vomiting for a week. He had very severe metabolic alkalosis (Ph-7.67), hypokalaemia (2.5 mmol/L) and hypochloraemia (60 mmol/L). He was amazingly still breathing spontaneously with no apnoea. His electrolyte imbalance was slowly reversed over 72 hrs and later he was transferred to a tertiary surgical care unit for corrective pyloromyotomy. He recovery was uneventful post surgery. We would like to share baby’s severe electrolyte imbalances and stimulate research on how much extremes of metabolic alkalosis infants can tolerate. Abdominal ultrasound Pylorus appears moderately thickened measuring to 2.1 cm in length (normally up to 1.5–1.7 cm). Pyloric transverse diameter measures to 1.7 cm (normally up to 1.3 cm) and pyloric muscle thickness was 8.9 mm Learning Points Slow correction of electrolyte imbalance is critical in treatment of pyloric stenosis. Observe very closely for apnoes in babies with severe metabolic alkalosis Always think of Pyloric Stenosis in infants presenting with constipation. Pyloromyotomy is performed only after baby’s metabolic alkalosis is normalized. References Dalton BG,Gonzalez KW, Boda SR et al,Optimizing fluid resuscitation in hypertrophic pyloric stenosis. Journal of Pediatric surgery 2016 Aug;51(8):1279–82. doi: 10.1016/j.jpedsurg.2016.01.013. Epub 2016 Feb 3. |
