Infants
1 month to 2 years of age
Hypertrophic pyloric stenosis
[edit | edit source]- 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
[edit | edit source]- 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.