Book contents
- Frontmatter
- Contents
- Preface
- 1 The elective repair of an abdominal aortic aneurysm
- 2 Adrenalectomy
- 3 Amputation (below knee)
- 4 Anorectal abscesses, fistulae and pilonidal sinus
- 5 Appendicectomy
- 6 Principles of bowel anastomosis
- 7 Breast surgery
- 8 Carotid endarterectomy
- 9 Carpal tunnel decompression
- 10 Central venous cannulation
- 11 Cholecystectomy (laparoscopic)
- 12 Circumcision
- 13 Colles' fracture (closed reduction of)
- 14 Compound fractures
- 15 Dupuytren's contracture release
- 16 Dynamic hip screw
- 17 Fasciotomy for compartment syndrome
- 18 Femoral embolectomy
- 19 Femoral hernia repair
- 20 Haemorrhoidectomy
- 21 Hip surgery
- 22 Hydrocele repair
- 23 The open repair of an inguinal hernia
- 24 Laparotomy and abdominal incisions
- 25 Oesophago-gastroduodenoscopy
- 26 Orchidectomy
- 27 Parotidectomy
- 28 Perforated peptic ulcer
- 29 Pyloric stenosis and Ramstedt's pyloromyotomy
- 30 Right hemicolectomy
- 31 Skin cover (the reconstructive ladder)
- 32 Spinal procedures
- 33 Splenectomy
- 34 Stomas
- 35 Submandibular gland excision
- 36 Tendon repairs
- 37 Thoracostomy (insertion of a chest drain)
- 38 Thoracotomy
- 39 Thyroidectomy
- 40 Tracheostomy
- 41 Urinary retention and related surgical procedures
- 42 Varicose vein surgery
- 43 Vasectomy
- 44 Zadik's procedure
29 - Pyloric stenosis and Ramstedt's pyloromyotomy
Published online by Cambridge University Press: 16 October 2009
- Frontmatter
- Contents
- Preface
- 1 The elective repair of an abdominal aortic aneurysm
- 2 Adrenalectomy
- 3 Amputation (below knee)
- 4 Anorectal abscesses, fistulae and pilonidal sinus
- 5 Appendicectomy
- 6 Principles of bowel anastomosis
- 7 Breast surgery
- 8 Carotid endarterectomy
- 9 Carpal tunnel decompression
- 10 Central venous cannulation
- 11 Cholecystectomy (laparoscopic)
- 12 Circumcision
- 13 Colles' fracture (closed reduction of)
- 14 Compound fractures
- 15 Dupuytren's contracture release
- 16 Dynamic hip screw
- 17 Fasciotomy for compartment syndrome
- 18 Femoral embolectomy
- 19 Femoral hernia repair
- 20 Haemorrhoidectomy
- 21 Hip surgery
- 22 Hydrocele repair
- 23 The open repair of an inguinal hernia
- 24 Laparotomy and abdominal incisions
- 25 Oesophago-gastroduodenoscopy
- 26 Orchidectomy
- 27 Parotidectomy
- 28 Perforated peptic ulcer
- 29 Pyloric stenosis and Ramstedt's pyloromyotomy
- 30 Right hemicolectomy
- 31 Skin cover (the reconstructive ladder)
- 32 Spinal procedures
- 33 Splenectomy
- 34 Stomas
- 35 Submandibular gland excision
- 36 Tendon repairs
- 37 Thoracostomy (insertion of a chest drain)
- 38 Thoracotomy
- 39 Thyroidectomy
- 40 Tracheostomy
- 41 Urinary retention and related surgical procedures
- 42 Varicose vein surgery
- 43 Vasectomy
- 44 Zadik's procedure
Summary
What is idiopathic hypertrophic pyloric stenosis (IHPS)?
This is a congenital condition that presents in infants at around 6 weeks of age. There is hypertrophy of the circular muscle of the pylorus causing gastric outflow obstruction. It is a familial condition and seen especially in the first-born males. IHPS is considered a surgical emergency as the infant is unable to feed and loses large quantities of acidic gastric fluid leading to dehydration, alkalosis and electrolyte imbalances.
What is the biochemical abnormality in an infant with pyloric stenosis?
Hypochloraemic metabolic alkalosis. The serum potassium and sodium may also be decreased. There may even be a paradoxical acid urine as the kidneys excrete hydrogen ions in order to preserve potassium.
How is IHPS diagnosed?
Classically there is a history of non-bilious projectile vomiting, dehydration and failure to thrive. The child remains hungry after each vomiting. Clinically the thickened pylorus can be palpated in the epigastrium as an olive-sized mass. The diagnosis can be further supported with a test feed and confirmed on ultrasound scanning.
What is the management of an infant with pyloric stenosis?
Fluid resuscitation using 0.45% normal saline with the addition of potassium chloride to each bag
NGT insertion and regular aspiration of the gastric contents
Surgery (Ramstedt's pyloromyotomy) after the alkalosis is corrected (typically after HCO3 is below 25 mmol/l)
Describe the steps taken in performing a Ramstedt's pyloromyotomy
Position The infant is placed supine with whole abdomen prepared and draped.
Incision Usually a right upper quadrant cutting or muscle splitting incision is used (upper midline, umbilical and laparoscopic approaches may also be used).
- Type
- Chapter
- Information
- Operative Surgery Vivas for the MRCS , pp. 107 - 110Publisher: Cambridge University PressPrint publication year: 2006