Pediatric surgery. Pyloric stenosis. Clinic (most important)

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Pediatric surgery. Pyloric stenosis. Clinic (most important)

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36. Pyloric stenosis. Clinic

To sharp forms pyloric stenosis This is a type of clinical manifestation of this malformation in which the symptoms of the disease begin suddenly and proceed violently.

clinical picture. The time of onset of symptoms of the disease depends on the degree of narrowing of the pyloric canal and the compensatory capabilities of the body. The first signs of the disease appear between the ages of several days and 1 month. The main symptom of the acute form of pyloric stenosis is “fountain” vomiting, which begins suddenly in the middle of full health. Vomit does not contain bile; its amount exceeds the amount of milk sucked during the last feeding. Often, vomit has a stagnant, sour odor, which indicates retention of gastric contents. Prolonged debilitating vomiting leads to a deterioration in the child’s general condition and disruption of water-salt metabolism (hypochloremia, exicosis, and sometimes hypokalemia). The acute stage of the disease is characterized by the fact that the child develops complete obstruction of the gastric patency within a few days. Feeding becomes impossible; a few sips of milk cause vomiting. Children lose up to 1-2 kg of body weight in 0,4-0,5 days. The number of urinations decreases. There is stool retention or dyspeptic “hungry” stool appears. An indicator of the serious condition of a child with pyloric stenosis is the daily loss of body weight in relation to birth weight (as a percentage). According to this classification, three forms of the disease are distinguished: mild (0-0,1%), moderate (0,2-0,3%) and severe (0,4% and above).

In children with acute pyloric stenosis, body weight loss reaches 6-8%. Upon examination, the child reacts poorly to his surroundings, with a pained expression on his face. The skin is pale, mucous membranes are bright and dry. The fontanelle sinks. Noteworthy is the swelling of the epigastric region, which decreases or disappears after vomiting. When stroking the abdominal wall or after several sips of food, you can notice waves of stomach peristalsis. Often the stomach takes on an hourglass shape. This symptom is a constant sign of congenital pyloric stenosis and is of great importance for establishing the diagnosis.

X-ray examination. First, a survey radiograph of the abdominal cavity is taken with the child in an upright position. This reveals a large gas bubble and a high level of fluid in the distended stomach. There is little or no gas in the intestinal loops. Then they begin the contrast study. In newborns in the first days of life, iodolipol (5 ml) is used as a contrast, observing its passage through the gastrointestinal tract. Lack of gastric emptying for more than 24 hours indicates an obstruction in the pyloric region.

Authors: Drozdov A.A., Drozdova M.V.

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