Editing Infants


1 month to 2 years of age

== Hypertrophic pyloric stenosis ==

* Occurs during first 2-12 weeks
* Progressive projectile non-bilious vomiting, usually after feeds
* Mostly male children
* Palpable olive in epigastrium has 99% PPV for it
* Electrolyte abnormalities - hypochloraemic, hypokalaemic metabolic alkalosis
* Diagnosis can be confirmed by USS (pyloric length >16mm and single wall thickness >3mm). A barium swallow can also be used, although is not often necessary.
* Treatment
** Defer surgery until the infant is fully resuscitated
** CSL 20ml/kg bolus the 1.5x maintenance until urine output and electrolytes are normalised
** Surgery
*** Extramucosal longitudinal splitting of the pyloric muscle
** Vomiting can persist for 24-48 hours

== Intussusception ==

* Peak incidence 6-9 months
* Majority ileocolic with hyperplastic lymphoid tissue in Peyer's patches acting as a lead point. <5% are due to pathological lead point.
* Classic triad - intermittent severe pain with drawing up of legs, palpable abdominal mass and 'red-currant jelly' stool. This picture is actually rare.
* USS has high sensitivity and is the test of choice.
* Treatment
** CO2 insufflation - 80-95% success rate. Can try again a few hours later if only partially successful. Pneumatic pressures 60-100mmHg recommended.
** Surgery for those that fail, or have signs of infarcted/perforated bowel. Manually reduce if possible. If not, resect.

[[Category:Paed Surg]]