Based on the clinical presentation, this patient has hypertrophic pyloric stenosis (HPS). HPS typically affects infants aged 2 weeks to 2 months and is characterized by projectile vomiting soon after feeding; the vomitus looks like undigested food. A palpable epigastric mass that resembles an olive is considered sufficient for diagnosis, but ultrasonographic evaluation of the pyloric length and thickness (transverse muscle thickness ≥ 4 mm) confirms the diagnosis. HPS is not an emergent condition, and the best outcomes are achieved by preoperative resuscitation aimed at rehydration and correction of metabolic alkalosis.2 Achieving a urine output of at least
1 mL/kg/hr and normalization of serum bicarbonate decreases the risk of respiratory depression, a potentially fatal complication of pyloromyotomy. Perioperative cefazolin administration is common, but antibiotics have little effect on outcomes because the incidence of surgical site infection is low (∼2%) and infections are typically mild and superficial. Postoperative feeding is safe once infants have fully recovered from anesthesia. Bouts of emesis are to be expected and typically resolve after 1 or 2 postoperative feedings. Supplemental oxygen is a routine component of postanesthetic care but does not impact the hypoventilation caused by dehydration and metabolic alkalosis. Fundoplication is used to treat gastroesophageal reflux.
- Preoperative fluid resuscitation.
2. Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg 2007;16:27-33.
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