Pylorostenosis

Pylorosthenosis is a malformation of the pyloric part of the stomach. The reason is the degeneration of the pylorus's muscular layer, its thickening, which is connected by a violation of innervation. As a result, the gatekeeper looks like a tumor-like formation of white color and cartilaginous conformation.

The first and main symptom of pyloric stenosis is vomiting "fountain", which appears at the end of the second - the beginning of the third week of life. Vomiting occurs between feedings, at first rare, then increases. The volume of vomit, consisting of curdled milk with an acidic odor, without bile impurities, in quantity exceeds the dose of a single feed. The child becomes restless, hypotrophy and dehydration develops, urination becomes rare, and a tendency to constipation appears.

When examining the abdomen in the epigastric region, a swelling and strengthened, segmented peristalsis of the stomach-the symptom of the "hourglass" -is determined. In 50-85% of cases under the edge of the liver, at the outer edge of the rectus muscle it is possible to palpate the doorkeeper, which looks like a dense tumor of a creamy shape, shifting from top to bottom. There is anemia of an alimentary character, a thickening of the blood (increase of the hematocrit). Due to losses of chlorine and cadia with vomiting, their level in the blood decreases, metabolic alkalosis develops. Decompensated form of pyloric stenosis occurs in patients relatively rarely.

To confirm the diagnosis of pyloric stenosis, a contrast X-ray examination of the stomach is used, in which an increase in its size and the presence of a liquid level during an examination on an empty stomach, a delay in the evacuation of the barium suspension, narrowing and lengthening of the pyloric canal (beak symptom).

One of the most informative methods for diagnosing pyloric stenosis is fibro-esophagogastroscopy. With pyloricrosis, endoscopy reveals a pinhole in the gatekeeper, the convergence of the folds of the mucous membrane of the antrum of the stomach toward the narrowed pylorus. When insufflation with air, the doorkeeper does not open, an attempt to hold the endoscope in the duodenum is impossible. At carrying out of atropine assay the gatekeeper remains closed (unlike pylorospasm). In many cases antrum-gastritis and reflux-esophagitis are detected.

Differentiate pyloric stenosis follows from various vegetosomatic disorders accompanied by pyloric stenosis, and pseudopylostenosis (Debreu-Phibiger syndrome).

Treatment of pyloric stenosis is only surgical. Operative intervention should be preceded by preoperative preparation aimed at restoring water-electrolyte and acid-base balance. The technique of the operation is in the extra-porous pyloromyotomy according to Fred-Ramstedt. Feeding after the operation is dosed, gradually increasing to the age norm by the 8th-9th day after the operation. Deficiency of fluid is replenished parenterally and by nutritional enemas. As a rule, the operation leads to complete recovery of the child.