The presence of dilated stomach bubble is suggestive but not diagnostic of pyloric stenosis. Criteria for making the diagnosis include pyloric muscle thickness greater than 4 mm or an overall pyloric diameter greater than 14 mm, or length greater than 26 mm. An UGI confirms the diagnosis of IHPS, but it is not routinely performed unless ultrasound is non-diagnostic. Upper GI endoscopy has been used as an adjunct diagnostic tool in select cases of IHPS when other imaging tests are inconclusive or when the infant presents with atypical clinical features. Resuscitation, if needed, should be performed according to PALS recommendations.
Immediate treatment requires correction of fluid loss, electrolytes and acid-base imbalance.
The child should be kept NPO preoperatively and until 12-24 hours after surgery. The Ramstedt pyloromyotomy is the procedure of choice, performed through a short transverse incision or laparoscopically. The underlying antro-pyloric mass is split leaving the mucosal layer intact. The infant should be hospitalized for initial medical treatment and a surgical consultation sought at the time. Close follow up is required after discharge.