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Most
infants "spit-up" from time to time. But babies with pyloric stenosis develop
progressively increasing frequency and forcefulness of vomiting, because the
muscle at the end of the stomach (the pylorus) becomes thicker and thicker and
blocks the passage of food into the intestine. Projectile vomiting develops,
in which the baby brings up milk or formula with great force. Sometimes the
vigorous contractions of the stomach, especially just after a feeding, can actually
be seen through the abdominal wall; these are called "gastric waves". A pediatric
surgeon is the most likely specialist to be able to feel the thick, oval, rubbery
muscle at the end of the stomach (called an "olive" because of its shape and
consitancy). If there is a strong suspicion of the diagnosis, and the "olive"
cannot be felt, a sonogram of the abdomen is the best study to confirm it. Rarely,
a X-ray study with barium is needed. If the baby is dehydrated or has lost a
lot of acid and body chemicals from prolonged vomiting, intravenous fluid and
salt replacement will be needed before the surgical procedure to open the pylorus.
The 20-minute operative procedure to split the thick stomach muscle is called
pyloromyotomy and is curative.
