Highlights & Basics
- Pyloric stenosis is a benign condition associated with recurrent projectile nonbilious vomiting, typically in a 2- to-12-week-old male infant.
- Features may include a history of feeding intolerance with multiple formula changes.
- Failure to thrive/weight loss may progress to increasing volume depletion. An olive-shaped mass may be palpable in the right upper abdomen.
- Ultrasound shows pyloric channel length >15 mm and pyloric muscle thickness >3 mm.
- Treatment is with intravenous fluid and electrolyte replacement, followed by pyloromyotomy (open or laparascopic).
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
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Citations
Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. 2007 Feb;16(1):27-33.[Abstract]
Expert Panel on Pediatric Imaging., Alazraki AL, Rigsby CK, et al. ACR Appropriateness Criteria® Vomiting in infants. J Am Coll Radiol. 2020 Nov;17(11s):S505-S515.[Abstract][Full Text]
Staerkle RF, Lunger F, Fink L, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis. Cochrane Database Syst Rev. 2021 Mar 9;3:CD012827.[Abstract][Full Text]
1. Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. 2007 Feb;16(1):27-33.[Abstract]
2. Donda K, Asare-Afriyie B, Ayensu M, et al. Pyloric stenosis: national trends in the incidence rate and resource use in the United States from 2012 to 2016. Hosp Pediatr. 2019 Dec;9(12):923-32.[Abstract][Full Text]
3. Jobson M, Hall NJ. Contemporary management of pyloric stenosis. Semin Pediatr Surg. 2016 Aug;25(4):219-24.[Abstract]
4. Ranells JD, Carver JD, Kirby RS. Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update. Adv Pediatr. 2011;58(1):195-206.
5. Stunden RJ, LeQuesne GW, Little K. The improved ultrasound diagnosis of hypertrophic pyloric stenosis. Pediatr Radiol. 1986;16(3):200-5.[Abstract]
6. Blumhagen JD, Maclin L, Krauter D, et al. Sonographic diagnosis of hypertrophic pyloric stenosis. AJR Am J Roentgenol. 1988 Jun;150(6):1367-70.[Abstract]
7. Kovalivker M, Erez I, Shneider N, et al. The value of ultrasound in the diagnosis of congenital hypertrophic pyloric stenosis. Clin Pediatr (Phila). 1993 May;32(5):281-3.[Abstract]
8. Neilson D, Hollman AS. The ultrasonic diagnosis of infantile hypertrophic pyloric stenosis: technique and accuracy. Clin Radiol. 1994 Apr;49(4):246-7.[Abstract]
9. Haider N, Spicer R, Grier D. Ultrasound diagnosis of infantile hypertrophic pyloric stenosis: determinants of pyloric length and the effect of prematurity. Clin Radiol. 2002 Feb;57(2):136-9.[Abstract]
10. Lamki N, Athey PA, Round ME, et al. Hypertrophic pyloric stenosis in the neonate - diagnostic criteria revisited. Can Assoc Radiol J. 1993 Feb;44(1):21-4.[Abstract]
11. Said M, Shaul DB, Fujimoto M, et al. Ultrasound measurements in hypertrophic pyloric stenosis: don't let the numbers fool you. Perm J. 2012 Summer;16(3):25-7.[Abstract][Full Text]
12. Eyal O, Asis A, Yorgenson U, et al. Atypical infantile hypertrophic pyloric stenosis. Harefuah. 1999 Jan 15;136(2):113-4,175. [in Hebrew][Abstract]
13. Veyrac C, Couture A, Bongrand AF, et al. Atypical pyloric stenosis in an infant with familial hyperlipidemia. Pediatr Radiol. 1996;26(6):402-4.[Abstract]
14. de Laffolie J, Turial S, Heckmann M, et al. Decline in infantile hypertrophic pyloric stenosis in Germany in 2000-2008. Pediatrics. 2012 Apr;129(4):e901-6.[Abstract]
15. To T, Wajja A, Wales PW, et al. Population demographic indicators associated with incidence of pyloric stenosis. Arch Pediatr Adolesc Med. 2005 Jun;159(6):520-5.[Abstract][Full Text]
16. Applegate MS, Druschel CM. The epidemiology of infantile hypertrophic pyloric stenosis in New York state, 1983 to 1990. Arch Pediatr Adolesc Med. 1995;149:1123-1129.[Abstract]
17. Schechter R, Torfs CP, Bateson TF. The epidemiology of infantile hypertrophic pyloric stenosis. Paediatr Perinat Epidemiol. 1997 Oct;11(4):407-27.[Abstract]
18. Sommerfield T, Chalmers J, Youngson G, et al. The changing epidemiology of infantile hypertrophic pyloric stenosis in Scotland. Arch Dis Child. 2008 Dec;93(12):1007-11.[Abstract]
19. Rasmussen L, Green A, Hansen LP. The epidemiology of infantile hypertrophic pyloric stenosis in a Danish population, 1950-84. Int J Epidemiol. 1989 Jun;18(2):413-7.[Abstract]
20. Kapoor R, Kancherla V, Cao Y, et al. Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: A multistate, population-based retrospective study, 1999-2010. Birth Defects Res. 2019 Feb 1;111(3):159-69.[Abstract]
21. Boybeyi-Turer O, Celik HT, Arslan UE, et al. Environmental exposure in the etiology of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Pediatr Surg Int. 2022 Jul;38(7):951-61.[Abstract]
22. Still G. Place in family as a factor in disease. Lancet. 1927;ii:795-853.
23. Habbick BF, Khanna C, To T. Infantile hypertrophic pyloric stenosis: a study of feeding practices and other possible causes. CMAJ. 1989 Feb 15;140(4):401-4.[Abstract][Full Text]
24. Stark CM, Rogers PL, Eberly MD, et al. Association of prematurity with the development of infantile hypertrophic pyloric stenosis. Pediatr Res. 2015 Aug;78(2):218-22.[Abstract]
25. Rogers IM. The true cause of pyloric stenosis is hyperacidity. Acta Paediatr. 2006 Feb;95(2):132-6.[Abstract]
26. Vanderwinden JM, Liu H, Menu R, et al. The pathology of infantile hypertrophic pyloric stenosis after healing. J Pediatr Surg. 1996 Nov;31(11):1530-4.[Abstract]
27. Okazaki T, Yamataka A, Fujiwara T, et al. Abnormal distribution of nerve terminals in infantile hypertrophic pyloric stenosis. J Pediatr Surg. 1994 May;29(5):655-8.[Abstract]
28. Vanderwinden JM, Liu H, De Laet MH, et al. Study of the interstitial cells of Cajal in infantile hypertrophic pyloric stenosis. Gastroenterology. 1996 Aug;111(2):279-88.[Abstract]
29. Vanderwinden JM, Mailleux P, Schiffmann SN, et al. Nitric oxide synthase activity in infantile hypertrophic pyloric stenosis. N Engl J Med. 1992 Aug 20;327(8):511-5 (erratum in: N Engl J Med. 1992 Oct 22;327(17):1252).[Abstract]
30. Subramaniam R, Doig CM, Moore L. Nitric oxide synthase is absent in only a subset of cases of pyloric stenosis. J Pediatr Surg. 2001 Apr;36(4):616-9.[Abstract]
31. Kusafuka T, Puri P. Altered messenger RNA expression of the neuronal nitric oxide synthase gene in infantile hypertrophic pyloric stenosis. Pediatr Surg Int. 1997;12(8):576-9.[Abstract]
32. Pandya S, Heiss K. Pyloric stenosis in pediatric surgery: an evidence-based review. Surg Clin North Am. 2012 Jun;92(3):527-39, vii-viii.[Abstract]
33. MacMahon B. The continuing enigma of pyloric stenosis of infancy: a review. Epidemiology. 2006 Mar;17(2):195-201.[Abstract]
34. Panteli C. New insights into the pathogenesis of infantile pyloric stenosis. Pediatr Surg Int. 2009 Dec;25(12):1043-52.[Abstract]
35. Krogh C, Gørtz S, Wohlfahrt J, et al. Pre- and perinatal risk factors for pyloric stenosis and their influence on the male predominance. Am J Epidemiol. 2012 Jul 1;176(1):24-31.[Abstract][Full Text]
36. Murchison L, De Coppi P, Eaton S. Post-natal erythromycin exposure and risk of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Pediatr Surg Int. 2016 Dec;32(12):1147-52.[Abstract][Full Text]
37. Almaramhy HH, Al-Zalabani AH. The association of prenatal and postnatal macrolide exposure with subsequent development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Ital J Pediatr. 2019 Feb 4;45(1):20.[Abstract][Full Text]
38. Cooper WO, Ray WA, Griffin MR. Prenatal prescription of macrolide antibiotics and infantile hypertrophic pyloric stenosis. Obstet Gynecol. 2002 Jul;100(1):101-6.[Abstract]
39. Mahon BE, Rosenman MB, Kleiman MB. Maternal and infant use of erythromycin and other macrolide antibiotics as risk factors for infantile hypertrophic pyloric stenosis. J Pediatr. 2001 Sep;139(3):380-4.[Abstract]
40. Shinohara K, Shimizu T, Igarashi J, et al. Correlation of prostaglandin E2 production and gastric acid secretion in infants with hypertrophic pyloric stenosis. J Pediatr Surg. 1998 Oct;33(10):1483-5.[Abstract]
41. Wilkinson DJ, Chapman RA, Owen A, et al. Hypertrophic pyloric stenosis: predicting the resolution of biochemical abnormalities. Ped Surg Int. 2011 Jul;27(7):695-8.[Abstract]
42. Costanzo CM, Vinocur C, Berman L. Prematurity affects age of presentation of pyloric stenosis. Clin Pediatr (Phila). 2016 Jul 20;56(2):127-31.[Abstract]
43. Forman HP, Leonidas JC, Kronfeld GD. A rational approach to the diagnosis of hypertrophic pyloric stenosis: do the results match the claims? J Pediatr Surg. 1990 Feb;25(2):262-6.[Abstract]
44. White MC, Langer JC, Don S, et al. Sensitivity and cost minimization analysis of radiology versus olive palpation for the diagnosis of hypertrophic pyloric stenosis. J Pediatr Surg. 1998 Jun;33(6):913-7.[Abstract]
45. Hulka F, Campbell TJ, Campbell JR, et al. Evolution in the recognition of infantile hypertrophic pyloric stenosis. Pediatrics. 1997 Aug;100(2):E9.[Abstract]
46. Macdessi J, Oates RK. Clinical diagnosis of pyloric stenosis: a declining art. BMJ. 1993 Feb 27;306(6877):553-5.[Abstract][Full Text]
47. Poon TS, Zhang AL, Cartmill T, et al. Changing patterns of diagnosis and treatment of infantile hypertrophic pyloric stenosis: a clinical audit of 303 patients. J Pediatr Surg. 1996 Dec;31(12):1611-5.[Abstract]
48. Touloukian RJ, Higgins E. The spectrum of serum electrolytes in hypertrophic pyloric stenosis. J Pediatr Surg. 1983 Aug;18(4):394-7.[Abstract]
49. Expert Panel on Pediatric Imaging., Alazraki AL, Rigsby CK, et al. ACR Appropriateness Criteria® Vomiting in infants. J Am Coll Radiol. 2020 Nov;17(11s):S505-S515.[Abstract][Full Text]
50. Hernanz-Schulman M, Sells LL, Ambrosino MM, et al. Hypertrophic pyloric stenosis in the infant without a palpable olive: accuracy of sonographic diagnosis. Radiology. 1994 Dec;193(3):771-6.[Abstract]
51. Tunell WP, Wilson DA. Pyloric stenosis: diagnosis by real time sonography, the pyloric muscle length method. J Pediatr Surg. 1984 Dec;19(6):795-9.[Abstract]
52. Iqbal CW, Rivard DC, Mortellaro VE, et al. Evaluation of ultrasonographic parameters in the diagnosis of pyloric stenosis relative to patient age and size. J Pediatr Surg. 2012 Aug;47(8):1542-7.[Abstract]
53. Rohrschneider WK, Mittnacht H, Darge K, et al. Pyloric muscle in asymptomatic infants: sonographic evaluation and discrimination from idiopathic hypertrophic pyloric stenosis. Pediatr Radiol. 1998 Jun;28(6):429-34.[Abstract]
54. Suwandhi E, Ton MN, Schwarz SM. Gastroesophageal reflux in infancy and childhood. Pediatr Ann. 2006 Apr;35(4):259-66.[Abstract]
55. Carre IJ. The natural history of the partial thoracic stomach (hiatus hernia) in children. Arch Dis Child. 1959 Aug;34:344-53.[Abstract]
56. Smith GA, Mihalov L, Shields BJ. Diagnostic aids in the differentiation of pyloric stenosis from severe gastroesophageal reflux during early infancy: the utility of serum bicarbonate and serum chloride. Am J Emerg Med. 1999 Jan;17(1):28-31.[Abstract]
57. Hajivassiliou CA. Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg. 2003 Nov;12(4):241-53.[Abstract]
58. Lui KW, Wong HF, Wan YL, et al. Antral web--a rare cause of vomiting in children. Pediatr Surg Int. 2000;16(5-6):424-5.[Abstract]
59. Gossman W, Eovaldi BJ, Cohen HL. Duodenal atresia and stenosis. 2019 May 19. StatPearls [internet publication].[Abstract][Full Text]
60. Jia WQ, Tian JH, Yang KH, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis: a meta-analysis of randomized controlled trials. Eur J Pediatr Surg. 2011 Mar;21(2):77-81.[Abstract]
61. Oomen MW, Hoekstra LT, Bakx R, et al. Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a systematic review and meta-analysis focusing on major complications. Surg Endosc. 2012 Aug;26(8):2104-10.[Abstract][Full Text]
62. Sathya C, Wayne C, Gotsch A, et al. Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis. Pediatr Surg Int. 2017 Mar;33(3):325-33.[Abstract]
63. Staerkle RF, Lunger F, Fink L, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis. Cochrane Database Syst Rev. 2021 Mar 9;3:CD012827.[Abstract][Full Text]
64. Lunger F, Staerkle RF, Muff JL, et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis - a systematic review and meta-analysis. J Surg Res. 2022 Jun;274:1-8.[Abstract][Full Text]
65. Ismail I, Elsherbini R, Elsaied A, et al. Laparoscopic vs. open pyloromyotomy in treatment of infantile hypertrophic pyloric stenosis. Front Pediatr. 2020;8:426.[Abstract][Full Text]
66. Hall NJ, Pacilli M, Eaton S, et al. Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet. 2009 Jan 31;373(9661):390-8.[Abstract]
67. Danielson J, Svenningsson A, Jansson P, et al. Controlled long term outcome of pyloromyotomy for pyloric stenosis: no long-term adverse effect. J Pediatr Surg. 2022 Apr 18:S0022-3468(22)00277-9.[Abstract][Full Text]
68. Yamataka A, Tsukada K, Yokoyama-Laws Y, et al. Pyloromyotomy versus atropine sulfate for infantile hypertrophic pyloric stenosis. J Pediatr Surg. 2000 Feb;35(2):338-41.[Abstract]
69. Kawahara H, Takama Y, Yoshida H, et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the "olive"? J Pediatr Surg. 2005 Dec;40(12):1848-51.[Abstract]
70. Lukac M, Antunovic SS, Vujovic D, et al. Is abandonment of nonoperative management of hypertrophic pyloric stenosis warranted? Eur J Pediatr Surg. 2013 Feb;23(1):80-4.[Abstract]
71. Hayashi AH, Giacomantonio JM, Lau HY, et al. Balloon catheter dilatation for hypertrophic pyloric stenosis. J Pediatr Surg. 1990 Nov;25(11):1119-21.[Abstract]
72. Miozzari HH, Tonz M, von Vigier RO, et al. Fluid resuscitation in infantile hypertrophic pyloric stenosis. Acta Paediatr. 2001 May;90(5):511-4.[Abstract]
73. Bertozzi M, Prestipino M, Nardi N, et al. Preliminary experience with a new approach for infantile hypertrophic pyloric stenosis: the single-port, laparoscopic-assisted pyloromyotomy. Surg Endosc. 2011 Jun;25(6):2039-43.[Abstract]
74. Yu LJ, Su BL, Shan WY, et al. Single-site umbilical laparoscopic pyloromyotomy using a pyloric electrocoagulation chisel combined with a left-handed main operation for congenital hypertrophic pyloric stenosis. J Laparoendosc Adv Surg Tech A. 2020 Nov;30(11):1248-52.[Abstract][Full Text]
75. Ji Y, Lai X, Xu Z. Transumbilical single-site two incision laparoscopic pyloromyotomy for pediatric hypertrophic pyloric stenosis. BMC Surg. 2022 Jun 7;22(1):218.[Abstract]
76. Papadakis K, Chen EA, Luks FI, et al. The changing presentation of pyloric stenosis. Am J Emerg Med. 1999 Jan;17(1):67-9.[Abstract]
77. Flageole HH, Pemberton J. Post-operative impact of nasogastric tubes on length of stay in infants with pyloric stenosis (POINTS): a prospective randomized controlled pilot trial. J Pediatr Surg. 2015 Oct;50(10):1681-5.[Abstract]
78. Adibe OO, Nichol PF, Lim FY, et al. Ad libitum feeds after laparoscopic pyloromyotomy: a retrospective comparison with a standardized feeding regimen in 227 infants. J Laparoendosc Adv Surg Tech A. 2007 Apr;17(2):235-7.[Abstract]
79. Sullivan KJ, Chan E, Vincent J, et al; Canadian Association of Paediatric Surgeons Evidence-Based Resource. Feeding post-pyloromyotomy: a meta-analysis. Pediatrics. 2016 Jan;137(1):1-11.[Abstract]
80. Acker SN, Kulungowski AM, Hodges M, et al. Pyloric stenosis-postoperative care on a nonsurgical ward. J Surg Res. 2015 Nov;199(1):149-52.[Abstract]
81. Clayton JT, Reisch JS, Sanchez PJ, et al. Postoperative regimentation of treatment optimizes care and optimizes length of stay (PROTOCOL) after pyloromyotomy. J Pediatr Surg. 2015 Sep;50(9):1540-3.[Abstract]
