Pediatric surgery. Differential diagnosis and treatment of pyloric stenosis (most important)

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Pediatric surgery. Differential diagnosis and treatment of pyloric stenosis (most important)

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37. Differential diagnosis and treatment of pyloric stenosis

Differential diagnosis acute form of pyloric stenosis should be carried out with pylorospasm, gastric obstruction, congenital high intestinal obstruction, habitual vomiting.

In children of the first days of life, differentiation with pylorospasm is of the greatest importance due to the different tactics used in their treatment. It should be borne in mind that with spasm, the disease begins gradually, with regurgitation, which is intermittent, without significantly affecting the general condition of the child and his body weight. In those cases when an X-ray examination is performed to differentiate these conditions, it should be borne in mind that with pylorospasm, gastric emptying begins 10 minutes after taking a contrast agent and ends after 3-6 hours.

Congenital obstruction of the stomach is clinically and radiographically extremely difficult to distinguish from the acute form of pyloric stenosis. Usually the final diagnosis is established during surgery.

Congenital anomalies of the duodenum, in which the obstruction is located below the nipple of Vater, is usually easy to distinguish from pyloric stenosis by bile-stained vomit and a characteristic x-ray picture.

Palpation determination of the thickened pylorus and the establishment of lengthening and narrowing of the pyloric canal during x-ray examination speak in favor of pyloric stenosis. Sometimes the contrast agent (with pyloric stenosis) remaining in the stomach may appear on the x-ray as two depots located on both sides of the spine, which is similar to the x-ray picture with high intestinal obstruction. In these cases, the diagnosis is aided by lateral radiography—the dilated duodenum is usually located posterior to the stomach.

Habitual vomiting and regurgitation are quite common in children in the first months of life, but this dysfunction of the stomach usually does not change the general condition of the child, does not cause a drop in body weight.

Treatment. Preoperative preparation. Preparation for surgery along with examination does not exceed 24 hours and is aimed at reducing disturbances in water-salt metabolism, as well as treating aspiration pneumonia. Immediately before the operation, gastric contents are suctioned.

Postoperative treatment. 3-4 hours after the operation, if no injury was noted to the mucous membrane of the stomach or duodenum, the child is given 7-10 ml of a 5% glucose solution through the nipple, after 1 hour - 10 ml of expressed breast milk, and then (if there is no vomiting) is prescribed 2 ml of milk every 10 hours. To prevent wound infection and complications, antibiotics are used (6-7 days). Vitamin therapy is prescribed. Sutures are removed on the 10-12th day after surgery.

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

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