Overview

Pyloric stenosis, also known as infantile hypertrophic pyloric stenosis, is a condition that mainly affects young infants. The pylorus is the muscular outlet between the stomach and the small intestine. In pyloric stenosis, this muscle becomes abnormally thickened, narrowing the opening and making it difficult for milk or food to pass from the stomach into the intestine.

The condition commonly develops during the first few weeks of life. Babies may develop progressively worsening, forceful vomiting after feeds and may remain hungry soon afterwards. Repeated vomiting can lead to dehydration, electrolyte disturbances and poor weight gain.

Early diagnosis and treatment are important. Pyloric stenosis treatment in infants generally involves correcting dehydration and electrolyte abnormalities first, followed by pyloromyotomy surgery to relieve the obstruction.

At Sarvodaya Hospital, a paediatric surgeon can evaluate infants with suspected pyloric stenosis, confirm the diagnosis with appropriate investigations and determine the most suitable surgical approach.

Symptoms of Pyloric Stenosis

• Forceful or projectile vomiting after feeding
• Vomiting that gradually becomes more frequent or severe
• Vomiting that is usually non-bilious
• Persistent hunger after vomiting
• Poor feeding
• Fewer wet diapers due to dehydration
• Excessive sleepiness or reduced activity
• Irritability
• Poor weight gain or weight loss
• Signs of dehydration
• Constipation or fewer bowel movements
• Visible stomach contractions after feeding in some infants

Causes of Pyloric Stenosis

• Genetic or familial factors
• Male sex, as the condition is more common in boys
• A family history of pyloric stenosis
• Certain early-life factors that may influence development of the pyloric muscle

Diagnosis of Pyloric Stenosis

Pyloric stenosis diagnosis involves a clinical assessment along with imaging and blood tests when required.

• Physical Examination : The paediatric surgeon may assess the baby's abdomen and look for signs such as visible stomach contractions. In some cases, the enlarged pyloric muscle may be felt as a small, firm mass in the upper abdomen.
• Ultrasound : Abdominal ultrasound is the standard imaging test commonly used to confirm pyloric stenosis. It can show thickening and enlargement of the pyloric muscle and narrowing of the passage into the intestine.
• Upper GI Study : An upper gastrointestinal contrast study may sometimes be considered when the diagnosis is uncertain or when other causes of vomiting need to be evaluated.
• The standard pyloric stenosis treatment is surgery. However, the infant must first be stabilised, particularly if there is dehydration or an electrolyte imbalance.
• Correction of Dehydration and Electrolyte Imbalance : Before surgery, the baby is usually given intravenous fluids to correct dehydration and abnormal electrolyte levels caused by vomiting.
• Pyloromyotomy Surgery : During the procedure, the surgeon makes a controlled incision through the thickened pyloric muscle without opening the stomach lining.
• Laparoscopic Pyloromyotomy : Laparoscopic pyloromyotomy is a minimally invasive approach performed through small openings in the abdomen.
• Role of Paediatric Surgical Care : Pyloric stenosis requires care specifically suited to infants. A paediatric surgical team can coordinate diagnosis, correction of dehydration and electrolytes, anaesthesia, surgery, feeding after surgery and follow-up.

Benefits of Early Pyloric Stenosis Treatment

• Correct dehydration and electrolyte abnormalities
• Relieve the obstruction at the stomach outlet
• Restore normal passage of milk into the intestine
• Improve feeding
• Support normal hydration and nutrition
• Prevent complications associated with prolonged vomiting
• Allow the infant to return to normal feeding and growth
• Reduce the risk of complications from prolonged untreated obstruction

Complications if Left Untreated

• Severe dehydration
• Electrolyte imbalance
• Poor weight gain
• Weight loss
• Nutritional deficiency
• Reduced urine output
• Increasing weakness or lethargy
• Further deterioration if treatment is delayed

Role of Early Intervention by a Paediatric Surgeon

• Helps confirm the diagnosis early: Evaluates persistent or forceful vomiting and uses appropriate investigations, such as ultrasound, to determine whether the infant has pyloric stenosis.
• Prevents dehydration and electrolyte imbalance: Identifies complications caused by repeated vomiting and ensures that fluids and electrolyte abnormalities are corrected before surgery.
• Protects the infant's nutrition and growth: Early treatment helps restore normal feeding and reduces the risk of poor weight gain or nutritional problems caused by persistent vomiting.
• Supports timely pyloromyotomy: Determines when the infant is medically ready for pyloromyotomy surgery and selects the appropriate surgical approach based on the child's condition.
• Provides infant-specific surgical care: Manages the infant before, during and after surgery with care tailored to their age, size and clinical needs.
• Supports safe recovery after surgery: Monitors feeding, hydration, wound healing and recovery so that the infant can return to normal feeding and routine activities.

When Should Parents See a Paediatric Surgeon?

• Repeated forceful vomiting after feeds
• Vomiting that is becoming progressively worse
• Persistent hunger despite repeated vomiting
• Poor feeding
• Fewer wet diapers
• Poor weight gain
• Signs of dehydration
• Increasing sleepiness or weakness
• Recurrent vomiting without an obvious explanation

Prevention & Lifestyle Modifications

• Seek Early Medical Attention: Have persistent or forceful vomiting assessed promptly rather than assuming it is normal infant spit-up.
• Monitor Feeding: Inform the paediatrician if the baby repeatedly vomits after feeds or remains unusually hungry after vomiting.
• Monitor Wet Diapers: A noticeable reduction in wet diapers can be a sign of dehydration and should be discussed with a doctor.
• Attend Follow-Up Appointments: Follow the paediatric surgeon's recommendations for monitoring feeding, weight and recovery after treatment.
• Follow Feeding Instructions: After surgery, follow the medical team's instructions regarding when and how feeds should be restarted.
• Monitor Recovery: Report persistent forceful vomiting, fever, wound problems, poor feeding or other concerning changes after surgery.

Pre- and Post-Treatment Care

Before Treatment

• Confirm the diagnosis with ultrasound.
• Assess the baby's hydration status.
• Perform blood tests to check electrolyte levels.
• Start intravenous fluids when required.
• Correct dehydration and electrolyte abnormalities.
• Assess the infant's overall condition before anaesthesia.
• Explain the planned surgical approach to the parents.
• Prepare the infant for laparoscopic or open pyloromyotomy as appropriate.

After Treatment

• Feeding tolerance
• Vomiting
• Hydration
• Urine output
• Pain and comfort
• Surgical wound condition
• Signs of infection or other complications

Reviewed & Updated On

Reviewed by Dr. Shweta K. Sharma Senior Consultant - Paediatric Surgery on 9 Aug 2026.