Pyloric stenosis in newborns. The main clinical manifestations in congenital pyloric stenosis and effective methods of treatment Congenital pyloric stenosis treatment

- a malformation of the gastrointestinal tract, characterized by an organic narrowing of the pylorus of the stomach, adjacent to the duodenum 12. Congenital pyloric stenosis manifests itself in the 2-4th week of a child's life with vomiting "fountain" that occurs after feeding, decreased body weight and skin turgor, oliguria, constipation. Methods for diagnosing congenital pyloric stenosis are ultrasound, X-ray and endoscopic examination stomach. Treatment of congenital pyloric stenosis is carried out only surgically and consists in performing pyloromyotomy.

General information

Against the background of constant vomiting in a child with congenital pyloric stenosis, dehydration and malnutrition rapidly progress, the frequency of urination decreases, and constipation appears. The child's stool is dark green due to the predominance of bile; urine becomes concentrated, leaves stained stains on the diapers.

As a result of violations of the water-salt balance, severe metabolic and electrolyte disturbances (hypovolemia, alkalosis), deficiency anemia, and blood clots develop. A complication of congenital pyloric stenosis can be an ulcerative lesion of the pylorus with ulcer perforation and gastrointestinal bleeding. Vomiting syndrome can lead to asphyxia, eustachitis, otitis media, aspiration pneumonia.

Diagnostics

A child with suspected congenital pyloric stenosis should be referred by a pediatrician to a pediatric surgeon. The diagnosis is confirmed by ultrasound, endoscopic, X-ray examination of the stomach.

When examining a child with congenital pyloric stenosis, swelling in the epigastric region, visible peristalsis of the stomach ("hourglass" symptom) is determined. In most cases, it is possible to palpate a hypertrophied pylorus, which has a dense consistency and a plum-like shape.

Laboratory tests (KLA, blood counts, blood biochemical analysis) are characterized by an increase in hematocrit, metabolic alkalosis, hypokalemia, hypochloremia.

For children with suspected congenital pyloric stenosis, ultrasound of the stomach with a water-siphon test is shown. When examining the pyloric canal, its tight closure, thickening of the muscle pulp, the absence of evacuation of the contents into the duodenum are noticeable. When carrying out esophagogastroduodenoscopy to a child with congenital pyloric stenosis, the antrum expands and the pyloric canal lumen narrows to the size of a pinhead. Unlike pyloric spasm, in congenital pyloric stenosis, the pyloric canal does not open during air insufflation. According to endoscopic data, reflux esophagitis is often detected in congenital pyloric stenosis.

Treatment of congenital pyloric stenosis

The presence of congenital pyloric stenosis in a child requires active surgical tactics. Conducting bougienage of the pylorus canal leads to its short-term opening and repeated stenosis.

Surgical treatment of congenital pyloric stenosis is preceded by preoperative preparation of the child, including infusion therapy with glucose-salt and protein solutions, the use of antispasmodics, replenishment of fluid deficiency and nutrients microclysters.

With congenital pyloric stenosis, a pyloromyotomy according to Frede-Ramstedt is performed, during which the serous-muscular layer of the pylorus is dissected to the mucous membrane, thereby eliminating the anatomical obstacle and restoring the patency of the pyloric canal. The operation is performed in an open, laparoscopic or transumbilical manner. In the postoperative period, dosed feeding is carried out, the volume of which is brought to the age norm by 8-9 days.

Forecast

Great experience surgical treatment congenital pyloric stenosis allows to achieve good long-term results and complete recovery of children. After the operation, children need dispensary supervision by a pediatrician, pediatric surgeon, a pediatric gastroenterologist with the aim of correcting hypotrophy, hypovitaminosis and anemia.

Without timely surgical treatment, a child with congenital pyloric stenosis can die from metabolic disorders, dystrophy, and septic complications (pneumonia, sepsis).

Congenital hypertrophic pyloric stenosis

Version: MedElement Disease Handbook

Congenital hypertrophic pyloric stenosis (Q40.0)

Congenital diseases, Gastroenterology

general information

Short description

Congenital pyloric stenosis (congenital hypertrophic pyloric stenosis, congenital hypertrophic pyloric stenosis) - congenital narrowing of the pyloric canal The pyloric canal (pylorus canal) is the end part of the stomach adjacent to the pylorus (the narrowed part of the stomach at the place of its transition to the duodenum.).
due to a malformation of all layers of the pyloric section of the stomach with thickening of the mucous membrane in the pyloric section, impaired innervation of the pyloric muscles and excessive proliferation of connective tissue in them.

Classification

When classifying, indicate the degree of violation of the patency of the pyloric canal, note the presence of complications (gastric pneumatosis, dehydration and its type, erosion of the stomach and esophagus).

Etiology and pathogenesis

It is a multifactorial disease, a hereditary predisposition plays a role in its development.
May occur due to intrauterine viral infections (cytomegalovirus, herpes), as well as gestosis Gestosis (toxicosis of pregnant women) is the general name for pathological conditions that occur during pregnancy, complicating its course.
, stress and other environmental influences on the mother's body.

Morphologically, pyloric stenosis is manifested by a thickening of the pyloric canal wall up to 3-7 mm (the norm is 1-2 mm). In healthy children of the first weeks of life, the gatekeeper The gatekeeper is the narrowed part of the stomach at the place of its transition to the duodenum.
has a rounded, onion-like shape and pink in color. In the case of pyloric stenosis, it lengthens and takes on an olive shape, cartilage density and white color.
Hypertrophy is revealed histologically Hypertrophy - the proliferation of an organ, its part or tissue as a result of cell proliferation and an increase in their volume
muscle fibers (mainly the circular layer), connective tissue septa thicken, edema occurs, and later - sclerosis of the mucous and submucous layers with impaired differentiation of connective tissue structures.

Epidemiology

Congenital pyloric stenosis occurs in the population with a frequency of 0.5: 1000 to 3: 1000. At the same time, the incidence of this disease in boys (1: 150) significantly exceeds this indicator in girls (1: 750). For 1 case of congenital pyloric stenosis in girls, there are 4-7 cases in boys.

Factors and risk groups

There is an established relationship between consanguinity of parents and the incidence of congenital hypertrophic pyloric stenosis. More often this defect occurs in the first child.
In 6.9% of cases, a family-hereditary predisposition was revealed. If there is a sick boy in the family, the risk for future brothers is 4%, for sisters - 3%. For future brothers and sisters of a sick girl, the risk is 9 and 4%, respectively.

Clinical picture

Symptoms, course

The disease develops gradually.
At the age of 2-3 weeks, the child begins to regurgitate, which turns into profuse vomiting at the 3-4th week of life. Vomit in the early stages can sometimes contain an admixture of bile, but as the degree of narrowing of the gatekeeper increases, bile disappears in the vomit. Then vomiting appears as a "fountain" when the volume of vomit exceeds the volume of the last feeding. Vomit has a sour, stagnant odor.
The child loses weight, his subcutaneous tissue becomes thinner, after a short period of time he begins to weigh less than at birth. Dystrophy with a typical clinical picture is steadily progressing. The body develops a deficiency of trace elements (iron, calcium, phosphorus) and vitamins.

The disease can have an acute course, with severe disorders of homeostasis Homeostasis is the relative dynamic constancy of the internal environment (blood, lymph, tissue fluid) and the stability of the basic physiological functions (blood circulation, respiration, thermoregulation, metabolism, etc.) of the body.
... At the same time, body weight loss reaches 15-20%. The child is characterized by lethargy, weakness, skin with a gray color and pronounced marbling, tachycardia, rare urination, constipation (although dyspeptic, "hungry" stools can also be observed). Since the child loses hydrochloric acid and chlorine, this disease is characterized by alkalosis.
There is a development of anemia, a violation of water and electrolyte metabolism, blood thickens.
In severe cases of pyloric stenosis, hemorrhagic syndrome with gastric bleeding, catarrhal-hemorrhagic esophagitis and antral gastritis.
Symptoms grow more slowly in case of insufficiency of the cardiac part of the stomach and reflux esophagitis: frequent regurgitation is noted, vomiting is less common, "fountain" vomiting is less pronounced, violations of the acid-base state are less pronounced.

When examining a child, they note:
- symptoms of hypotrophy Hypotrophy is an eating disorder characterized by varying degrees of underweight
and dehydration;
- an increase in the epigastric region in comparison with the sunken lower abdomen;
- visible to the eye peristalsis of the stomach in the form of an hourglass (especially during feeding). You can induce peristalsis by lightly stroking the epigastric region.
- sometimes it is possible to palpate the thickened pylorus.

The child has scanty, dark green stools (due to insufficient supply of milk to the intestines and the predominance of bile and secretion of the intestinal glands in the chyme).
Urination is infrequent with reduced urine output; concentrated urine.
As a result of vomiting, asphyxia, aspiration pneumonia may appear. The disease may be supplemented by such purulent-septic complications as osteomyelitis, pneumonia, sepsis.

Diagnostics

Pyloric stenosis should be suspected when the following symptoms are present:
1. Vomiting "fountain" from 2-3 weeks of age with a constant frequency.
2. The amount of milk excreted during vomiting is greater than the amount of milk sucked out.
3. A sharp decrease in body weight - body weight is less than at birth.
4. Significantly reduced number of urinations (about 6).
5. The presence of severe constipation (in most cases).
6. Appearance of the "hourglass" symptom after feeding.
7. Sharp pallor of the skin.
8. The child is lethargic, calm, his condition is progressively worsening.

Instrumental diagnostics

Mandatory research: Ultrasound and gastroduodenoscopy.

Ultrasoundallows you to see the pyloric olive in longitudinal and cross sections, to determine the nature of gastric peristalsis and to observe the movement of gastric contents through the pyloric canal.

Normally, in children of the first months of life, there is no content in the stomach on an empty stomach, the length of the pylorus does not exceed 18 mm, the lumen of the pyloric canal is well visualized, the thickness of the muscular layer of the wall is no more than 3-4 mm, the diameter of the pylorus is no more than 10 mm.

In case of hypertrophic pyloric stenosis during an ultrasound scan on an empty stomach, a large amount of liquid content is found in the stomach, peristalsis is deep, "pulling". When a peristaltic wave passes, the pyloric canal is rigid and does not open, its length is on average 21 mm (from 18 to 25 mm), the outer diameter of the pylorus is 14 mm (from 11 to 16 mm).
On a longitudinal section, the circular muscle is represented by two parallel hypoechoic stripes, between which there is an echogenic strip of the mucous membrane. On a cross section, the circular muscle is visualized as a hypoechoic ring around the echogenic circle of the mucous membrane. The muscle thickness averages 5 mm (3 to 6 mm).

EGDS in the case of pyloric stenosis, it reveals an expansion of the stomach, a sharp narrowing and rigidity of the pyloric canal, often - cardia insufficiency. In the stomach on an empty stomach, liquid contents are often found, the walls of the stomach are hypertrophied, peristalsis is enhanced, or the stomach is atonic, erosion can be found on the gastric mucosa.

Additional research

X-ray examination of the stomach with barium

Direct radiological signs: change in the shape, size and function of the antropyloric part of the stomach.

If the narrowing of the pylorus is pronounced, as a result of gastric peristalsis, the contrast agent fills only the initial part of the pyloric canal, without penetrating into the duodenum (a symptom of "antropyloric beak"). The wall of the stomach hangs over the narrowed pyloric canal at the base of the "beak"; as a result, a kind of intussusception (introduction) of the thickened pylorus into the lumen of the antrum occurs - a symptom of "shoulders" or "curly braces".

With less severe stenosis Stenosis is a narrowing of a tubular organ or its external opening.
the radiographic image shows the entire pyloric canal. It is significantly elongated (the symptom of the "antennae" or "flagellum").
The symptom of "parallel lines", which is formed by dilated folds of the mucous membrane, is a sign of narrowing of the pyloric canal due to muscle hypertrophy and thickening of the mucous membrane.

The identification of at least one of the listed direct signs allows us to consider the diagnosis of congenital hypertrophic pyloric stenosis verified.
Indirect signsindicate changes in the evacuation function, as well as a change in the pattern of gas distribution along the intestinal loops.

The most significant of them:
1. Reducing the amount of gas in the intestinal loops with a distended stomach;
2. Segmenting accelerated peristalsis of the stomach, sometimes of the "hourglass" type: an elongated and narrowed pylorus does not contract. Even with increased peristaltic contractions of the stomach, its contents do not move into the duodenum for a long time - a symptom of delayed evacuation. 24-72 hours after the intake of barium, part of it is still observed in the stomach.

Laboratory diagnostics

Mandatory research: general analysis blood count, hematocrit, general urine analysis.

Additional research: biochemical analysis blood (potassium, sodium, chlorine, acid-base state).

Differential diagnosis

Differential diagnosis carried out with diseases accompanied by persistent vomiting:
- pylorospasm;
- chalasia and achalasia of the esophagus;
- rare vices development: narrowing of the esophagus, esophageal atresia, duodenal atresia;
- hypoxic-ischemic damage to the central nervous system;
- adrenogenital syndrome;
- hypoaldosteronism;
- meningitis and other infectious and inflammatory diseases.

When congenital pre-pyloric stenosisvery similar to pyloric stenosis is observed clinical picturecharacterized by high intestinal obstruction... The final diagnosis is made on the basis of ultrasound, EGDS, X-ray examination.

When conducting differential diagnostics, you should exclude pylorospasm... Unlike pyloric stenosis with pylorospasm:
- vomiting from birth, irregular.
- the amount of milk sucked out is greater than the amount of milk excreted during vomiting;

The child's body weight at the time of examination is greater than at birth, it is normal or slightly behind (in most cases);

The number of urinations is moderately reduced (10-15), there is no oliguria;
- spastic constipation is possible, but sometimes the stool is independent;
- when eating, there is no visible peristalsis of the stomach (in most cases);
- the skin is not too pale;
- the child is loud, his condition is not significantly disturbed.

In diagnostics and differential diagnosis stenosis and esophageal diverticulum the leading role is played by esophagoscopy and X-ray examination.

Vomiting can also be caused by a doubling of the esophagus or a congenital short esophagus. The diagnosis is confirmed with the help of EGDS and X-ray examination, while violations by the gatekeeper are not detected.

Complications

Violation of trophism, dehydration.

Treatment

Currently, the main treatment for pyloric stenosis is surgical.

Surgery

When the diagnosis is established, all children undergo extramucosal pyloromyotomy according to Frede-Ramstedt.
Preoperative preparation of children in serious condition includes infusion rehydration, correction of water-salt metabolism and acid-base state (rheopolyglucin, 5% glucose solution, 5% albumin solution, amino acid solutions, Panangin, vitamin C, calcium preparations and vitamins, physiological solution, Ringer's solution). In case of 12-hour preparation, enteral nutrition is not prescribed. When more preparation is needed, the baby is fed with expressed breast milk or an adapted mixture of 10 ml after 2 hours.

Drug-free treatment
On the first day after the operation, the child should be fed 10-20 ml of expressed breast milk every 2 hours, gradually the feeding volume increases (by 100 ml every day). Transfer to breastfeeding is possible if the condition improves by 6-7 days after the operation.

Drug treatment
In the first days after the operation, infusion therapy is carried out with solutions of amino acids, glucose, trace elements, vitamins. This is necessary to correct metabolic disorders and to obtain a sufficient amount of nutrition.

In the complex of treatment, drugs that protect the mucous membrane (Maalox, Fosfalugel, etc.), vitamins, biological products (Bifiform, Linex), enzymes (Creon, Pancitrat, etc.) are used. In the case of the addition of purulent-septic diseases (pneumonia, sepsis, osteomyelitis), the appointment of antibacterial agents is indicated.

Forecast

• Self-medication can cause irreparable harm to your health.
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Unfortunately, it happens that at birth or within a few weeks after, doctors can diagnose the onset of the development of a particular disease in a baby. Fortunately, diseases diagnosed on time are often easily treatable, and in the future they no longer remind of themselves. Today I propose to talk about one of these - pyloric stenosis. Let's find out what it is, what the symptoms are, and also discuss what reasons can trigger its development.

Pyloric stenosis is one of the most severe pathologies of the gastrointestinal tract. Its essence lies in the fact that there is a narrowing of the outlet section of the stomach, which is adjacent to the duodenum. The disease can be diagnosed from the second week of life. It should be noted that the likelihood of this disease occurring is quite low, and occurs in 1-4 children for every 1000 newborns. For the sake of fairness, we note that boys are much more likely to get sick than girls. Pyloric stenosis in newborns is quite severe, and only surgical method, and in case of an untimely operation, even a lethal outcome is possible.

Development reasons

Unfortunately, to date, there is no exact data on what is the reason for its development. However, most physicians and scientists attribute the appearance of pyloric stenosis to certain adverse events during pregnancy. These include:

• Migrated infectious diseases in the early stages of gestation.
• Severe toxicosis at the beginning or at last weeks pregnancy.
• Disorders in the endocrine system.
• Taking certain medications.
• Hereditary factor.

It is believed that such complications during pregnancy lead to the fact that this very outlet of the gastrointestinal tract, which is adjacent to the duodenum, is covered with an absolutely inelastic, dense connective tissue, which is not able to accommodate the required amount of food. This disease is easy to diagnose, as it has pronounced symptoms. Which ones, let's analyze further.

This disease is of two forms: congenital and acquired. However, even if the newborn has congenital pyloric stenosis, it will be possible to diagnose it not earlier than the 2nd week of the baby's life. It is impossible to miss the beginning of its development, since the symptoms that are characteristic of this disease progress at a tremendous rate.

Below is the a list of symptoms that are characteristic of this disease:

1. - Vomiting in a child - occurs infrequently, but at the same time, the volume of vomit is much larger than the volume of food eaten. A newborn can vomit abruptly, so to speak, with a "fountain", and each time it will intensify.
2. Vomit has a sour odor, but there is no bile impurity in them.
3. A clear process of dehydration of the child's body begins.
4. The newborn actively begins to lose weight, urine becomes very small, at the same time, it becomes concentrated: it has a bright yellow color and a concentrated smell.
5. There may be a sinking fontanelle.
6. The child is emptied poorly, often the baby is tormented by constipation.
7. Loss of elasticity skin... That is, if, for example, you collect the skin in a fold, then it will remain in this state for a long time.
8. Coma. In addition, children with pyloric stenosis are very restless, often naughty and sleep poorly. Babies with this disease are very harsh. They are many times stronger than that, so you will hardly notice that children with such a diagnosis have fun or play.

Be long time without food, the newborn cannot, therefore this disease requires immediate medical advice and immediate surgical intervention. Otherwise, everything can end in death.

Diagnosis of the disease

Diagnosis of pyloric stenosis is carried out only within the walls of a medical facility. Here several main stages of diagnosis:

1. Interviewing parents and studying the main symptoms and complaints that bother the baby.
2. Examination of the patient and palpation of the abdomen. Usually, already at this stage, the doctor can see a characteristic sign of the disease - the stomach takes the shape of an hourglass, and a characteristic depression appears in the stomach area.
3. An ultrasound or X-ray examination with a contrast suspension may be prescribed.
4. Additionally, a biochemical blood test is prescribed, which, with pyloric stenosis, shows increased hemoglobin, since the blood thickens, and eSR indicators, chloride and sodium decrease due to constant vomiting.

It is very important to diagnose the disease correctly and on time, since, firstly, pyloric stenosis has very similar symptoms with another disease - pylorospasm, and for effective treatment it is important to diagnose it correctly. Secondly, pyloric stenosis is a dangerous disease that, if improperly treated, can lead to the death of a newborn.

Treatment of pyloric stenosis

In this case, the only possible treatment option is surgery, which involves several stages:

1. Preparation of a newborn for surgery is carried out within 2-3 days. All this time, he is injected with a solution of glucose and electrolytes. In addition, this is done with the aim of maintaining a small body during fasting and from dehydration.
2. The operation itself is performed. To do this, the surgeon dissects the gatekeeper and adjusts the outlet to the optimal size.
3. Recovery phase. The rehabilitation process is mainly about feeding. Begin to feed the newborn in very small portions, gradually increasing to the desired dosage.

Video

I suggest you watch a short video in which the surgeon explains what pyloric stenosis is, and how it differs from such a disease similar to it as pylorospasm.

Childhood diseases are one of the most extensive and rich in discussion and debate topics. Indeed, this is true, the opinions of doctors did not agree not only on the treatment of many diseases, but even on the intricacies of caring for a newborn with certain complications. So, for example, doctors do not even have a consensus regarding that. All doctors were divided into two groups, as you yourself understand, some say that it is possible, while others do not. Of course, even with more serious illnesses, there will certainly be some kind of "point of contention."

Today we discussed such a serious disease as pyloric stenosis. Oddly enough, but the opinion of doctors regarding the method of treatment is unanimous, but as for the causes of this kind of disease, there are several controversial issues.

Perhaps you know some other reasons that can cause the development of pyloric stenosis in a newborn, then share with us in the comments on the site.

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This is one of the most frequent reasons partial high obstruction in children during the first weeks and months of life. Thickening of the pyloric stenosis was first noted by M. Hirschprung in 1887. It is regarded as a defect of the innervation of the pyloric pulp. At first, a deficiency of innervation causes a spastic state of the pulp, and then, under its influence, the smooth muscle fibers of the pylorus are degenerated. Smooth muscle fibers are large, with a large nucleus.

In some cases, atypism of the mucous membrane of the pylorus is revealed - dystopia and the formation of multiple cystic cavities in the thickness of the muscle layer. Nerve nodes of the muscle layer are surrounded by fibrous tissue, nerve cells are shriveled, glial elements are hyperplastic, bundles nerve fibers in serous membrane deformed. IN last years proven genetic nature this malformation. The relative risk of pyloric stenosis among relatives is quite high, and it is higher in the sons of patients, which indicates a partial dependence of the inheritance of the defect on sex.

The gatekeeper thickens, lengthens, becomes dense and glassy, \u200b\u200band its lumen sharply narrows. Clinical manifestations become most noticeable by the beginning of the third week of a child's life and progress. The most striking clinical manifestation of pyloric stenosis is the characteristic "fountain" vomiting. It is observed 1 - 1.5 hours after feeding. Its content is curdled milk without bile with a sour odor and sour reaction. The amount of vomit exceeds the amount of food eaten before, since it remains in the stomach from previous feedings. In some cases, streaks of blood can be seen in the vomit. Rather severe stomach bleeding sometimes occurs.

Constipation appears, urination becomes more rare. Prolonged persistent vomiting leads to exhaustion. The face of a child with sunken eyes, the skin becomes flabby, dry due to constant dehydration. A characteristic feature pyloric stenosis is an increased peristalsis of the stomach, visible through a thinned abdominal wall in the form of an hourglass: in the epigastric region, two rounded protrusions appear with a bridge in the center, gradually smoothing out and disappearing. Peristalsis is better detected after feeding. It can be provoked by lightly stroking the epigastrium with your fingers. Data laboratory research indicate a thickening of blood (a decrease in BCC, an increase in hemoglobin, hematocrit), hypochloremia, hypokalemia, metabolic alkalosis.

When x-ray examination pay attention to an increase in the size of the stomach, the presence of a high level of fluid on an empty stomach, a reduced gas filling of the intestinal loops. X-ray contrast study is performed in upright position 30-40 minutes after giving contrast agent (5% aqueous suspension of barium in breast milk in the amount of a single feed). Segmented peristalsis of the stomach and the absence of primary evacuation into the duodenum are visible. On the lateral X-ray, a narrowed pyloric canal-symptom of the "beak" is determined. All radiographs should be taken with the child upright. As a rule, no further examination is required.

Recently, for the diagnosis of pyloric stenosis used fibroesophagogastroscopy. In this case, an expanded folded antrum of the stomach is visible, the lumen of the pyloric canal is sharply narrowed to the size of a pinhead, and does not open when inflated with air (in contrast to pyloric spasm). In addition, fibroscopy makes it possible to examine the esophagus, to determine the severity of reflux esophagitis, which often accompanies pyloric stenosis. Possible and ultrasound diagnostics pyloric stenosis. An experienced ultrasound operator not only states the presence of a hypertrafied pylorus, but can measure its length and width, the length of the pyloric canal, the thickness of the muscle layer and mucous membrane. The advantage of the method is its non-invasiveness and absence of radiation exposure.

Treatment

Operation is a radical method of treating pyloric stenosis. Since 1912, extramucosal pyloromyotomy according to Fred - Ramstedt is generally accepted. The intervention is preceded by preoperative preparation aimed at correcting hypovolemia, alkalosis, hypokalemia. During the operation, the anatomical obstacle is removed and the patency of the gatekeeper is restored. After 3-6 hours after the operation, the child is given a 5% glucose solution, then 5-10 ml of milk after 2 hours.

On the next day, the amount of milk is increased daily by 100 ml (10 ml per feeding). By the 6th day, the feeding volume is increased to 60 - 70 ml with an interval of 3 hours, after which the child is transferred to normal feeding. In the first days after surgery, the deficiency of fluids, electrolytes, protein and other ingredients is replenished by infusion therapy and subsidiary parenteral nutrition, as well as the appointment of microclysters (5% glucose solution and Ringer-Locke's solution in equal amounts of 30 ml, 4 times a day in a warm form).

One of the complications of the operation may be mucosal injury. duodenum... Damage is detected by compression of the stomach wall and movement of its contents through the pylorus. With perforation, air bubbles appear in the lower corner of the wound, and sometimes the contents of the intestine. The detected hole is sutured with one or two sutures in the transverse direction. Repeated pyloromyotomy is performed on the opposite side of the pulp. The prognosis is favorable. Children demand dispensary observation for the purpose of further treatment of malnutrition, anemia, hypovitaminosis.

Bychkov V.A., Manzhos P.I., Bachu M., Rafik Kh., Gorodova A.V.

The diagnosis of pyloric stenosis cannot be classified as a simple one, since this problem without surgical intervention impossible. According to statistics, in boys, this pathology occurs 4 times more often than in girls, and it is found in most cases immediately after the birth of a child. With pyloric stenosis, the outlet of the stomach, called the "gatekeeper", is unable to perform its function, and therefore food from the stomach cannot pass further along the digestive tract.

The consequences of the problem are not long in coming - food stagnates, is not completely digested and is not absorbed. In the case of this disease, the promptness of taking measures is extremely important, otherwise the disease will be fatal, since with such a pathology the child's body simply cannot function. So who is at risk of pyloric stenosis and how to save the baby?

Causes of the problem

The complexity of the disease is that doctors cannot accurately name the direct reasons that provoke its development. A number of sources speak of the influence of a number of factors that, under certain circumstances, can provoke the development of pathology in a child:

• mother transferred to early date pregnancy, a viral disease;
• severe pregnancy, serious toxicosis in the early stages;
• the presence of diseases in the mother within the endocrine system;
• taking certain medications while carrying a child;
• hereditary factor.

Under the influence of these factors, disturbances in the laying of the stomach occur in the area of \u200b\u200bits outlet, and part of the muscle tissue or all of it is completely replaced by tissue that is not capable of stretching. As a result, the outlet from the stomach becomes extremely narrow, which provokes partial or complete obstruction.

Factors creating favorable conditions for the development of pyloric stenosis (photo)

In medical practice, there have been small patients in whom the area of \u200b\u200bthe pylorus of the stomach had a microscopically thin opening, which made it impossible to function digestive tract... In such a situation, the problem manifests itself earlier, and you need to take remedial measures very quickly.

In rare cases, the disease develops as acquired, and in this case, the patient's age will be older. The following problems can provoke a disruption in the work of the gatekeeper: peptic ulcer, chronic gastritis, intestinal or stomach polyposis, Crohn's disease, chronic appendicitis, etc.

Symptomatic manifestations of the disease

Suspicions of pyloric stenosis, if present, arise rather quickly. Unlike the reasons, which are not exactly known, the symptoms of this disease are specific and obvious, proceed without symptomatic manifestations this pathology cannot at all. With a congenital manifestation in mild form present from the very birth, but by about the second or third week the picture becomes bright and the situation worsens every hour. Pyloric stenosis in a child can manifest as follows:

Since the child cannot eat normally due to pyloric stenosis, this disease poses a direct threat to the baby's life.

If the disease befell at an older age, then painful sensations in the abdomen can be noted as a symptom - they are also present in infants, but unlike adults, they cannot indicate this.

Treatment of pyloric stenosis in children

Pathology is found in the first weeks of life and is characterized by a severe course. To make a diagnosis, it may be enough for a doctor to familiarize himself with the symptomatic picture. With pyloric stenosis, a characteristic external change in the child's body takes place - the stomach visually begins to resemble an hourglass with a narrowing in the stomach area. An x-ray and a blood test are required for an accurate diagnosis. The main task of the doctor at the stage of diagnosis is to differentiate pathology from pylorospasm, since the latter does not require surgical intervention.

Treatment of pyloric stenosis has no alternatives - surgery is indicated. During the operation, doctors dissect the muscle layers of the pylorus down to the mucous membrane. After such an intervention, feeding the child with expressed breast milk begins within a few hours, constantly increasing the volume of food. It is applied to the breast only after at least 4 days after the operation, but the basis of feeding is still expressed milk. Fully transfer the baby to breast-feeding it is possible a week after the intervention.

If the operation and the postoperative period go according to the doctors' plan, then they give a guarantee that after the pathology is eliminated, the child will develop and grow normally.

If pyloric stenosis is acquired in nature, then the prognosis depends on what kind of cause led to the development of the problem. In some situations, surgeons have to remove part of the stomach and form a normal exit from it. The main goal of a specialist in any situation is to try to minimize the amount of intervention, so if there is a chance to leave the stomach intact, then doctors do so.