Baby Vomiting Forcefully After Feeding | Congenital Hypertrophic Pyloric Stenosis

Congenital Hypertrophic Pyloric Stenosis is a disease of the gastrointestinal pylorus part of stomach of newborns. There are specific symptoms of this disease and if this disease is ignored, the life of the baby may go in danger. So it is very important to be aware of this disease.

Let’s learn the right information about congenital hypertrophic pyloric stenosis. Let us first know the structure of the stomach.

What is the anatomy of the stomach?

When a baby drinks milk, it passes through the mouth into the esophagus and from the esophagus it moves to stomach. The stomach has four parts. The initial part attached to the esophagus is the cardia. The front part of the cardia is the fundus and the next part is the body and the last part is the pylorus.

This part of the pylorus is connected to the small intestine and acts as a valve. So when the food is digested in the stomach, it opens and food enters the small intestine.

What is congenital hypertrophic pyloric stenosis?

As the name of disease  suggest, it is a congenital disease. Hypertrophic Pyloric Stenosis is an thickening of pyloric muscle which lead to obstruction.

Thickening of the pylorus increases after birth. Therefore, when the baby is one month old, pylorus thickening increases and it gets swollen and the passage becomes very small, so the milk cannot enter the small intestine and it accumulates in the stomach, so the baby’s stomach become full so, baby vomits.

congenital hypertrophic pyloric stenosis

The disease is seen in 2-3 out of 1000 babies born. The disease is four times more common in boys than in girls. Heredity also causes the disease.

The disease is more common in pre term babies than in full term babies. If the mother smokes during pregnancy, the baby is more likely to get the disease.

Symptoms of the disease appear when the baby is one month old. In this disease, the baby does not grow normally due to insufficient food intake and frequent vomiting. Therefore, early diagnosis and treatment of this disease is very important.

What are the symptoms of congenital hypertrophic pyloric stenosis?

Symptoms of pyloric stenosis appear from 3-4 weeks of age and within 4-5 months. Therefore, this disease is also called Infantile Hypertrophic Pyloric Stenosis. The symptoms of pyloric stenosis are as follows.

1) Vomiting after breast feeding – The baby vomits forcefully after drinking milk. This vomit is thrown away at distance. Initially, vomiting is mild. But as the path of the pylorus gets shorter, the rate of vomiting increases more. The vomit is white. Frequent vomiting reduces the amount of sodium, potassium and gastric acid in the baby’s body. So it starts to have an adverse effect on the body.

2) Frequent hunger cry – As the baby does not digest milk, the baby gets hungry always and the baby is always crying for hunger.

3) Understand the peristalsis movement of the stomach on the abdomen – The movement of the stomach is seen on the baby’s abdomen after feeding and before the baby vomits. At such times the gastric muscles try to push the milk in the stomach forward into the small intestine.

4) Dehydration – Due to frequent vomiting and lack of feeds for the baby, dehydration starts and the baby becomes lethargic.

5) No defecation – The baby does not defecate as there is no food digestion and hence the baby does not gain weight or loses weight.

How is congenital hypertrophic pyloric stenosis diagnosed?

Doctors diagnose congenital hypertrophic pyloric stenosis in a baby based on its symptoms and physical examination. Doctors find out from a stomach examination that there is a lump in the upper part of the abdomen.

The lump is similar in size of an olive fruit. Also, before the baby vomits or after weaning, the area shows movement like a wave on the abdomen. From this, doctors diagnose pyloric stenosis. The following types of tests are also performed to confirm the diagnosis.

1) Blood tests – These tests include electrolytes in the baby’s body as well as hemoglobin and pre-operative tests.

2) Abdominal sonography – Sonography shows the extent of pylorus thickening in the stomach.

3) X-ray of the abdomen – X-ray of the baby’s abdomen is taken after giving the baby a special dye called barium. This X-ray shows an obstruction near the pylorus of the stomach. This examination is performed if physical examination as well as abdominal sonography is not possible.

What is the treatment for congenital hypertrophic pyloric stenosis?

Surgery is the only permanent treatment for pyloric stenosis. But before doing so, it is very important to stabilize the baby’s health as often the baby with this disease comes to the hospital as he is very lethargic. So it is very important to fit the baby for the operation. The following types of treatment are used for this.

1) The baby is given IV Fluids – the baby is given as much saline as he needs to normalize the dehydration and electrolyte balance of the baby’s body. So the baby become fit for the operation.

2) The baby is operated – After the baby is fit for the operation, the pediatric surgeon explains the complete information about the operation. The baby should not be breastfed before the operation as the operation is performed under anesthesia. This prevents the baby from vomiting while being anesthetized.

After anesthesia, the surgeon makes an incision on the baby’s abdomen and then makes a horizontal incision on the enlarged pylorus of the stomach. This clears the pylorus passage and allows milk from the stomach to enter the small intestine without obstruction. The incision made in the baby’s abdomen is then closed by sutures. This operation is called a Ramstead pyloromyotomy.

The operation may take one to one and a half hours. The baby can be admitted to the hospital for two to three days after the operation. The baby’s vomiting rate after the operation become very low.

Timely treatment and surgery by a specialist pediatrician avoids endangering the baby’s life. The success rate of pyloromyotomy is good and the baby will not suffer from it in future. Follow the doctor’s advice after the operation. As the baby begins to digest the milk, the baby begins to gain weight over the next few days.

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Dr Nikhil Rane is Consultant pediatrician and neonatologist. He likes to provide proper care for children health. He is blogger since last 7 years

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