Submission Type

Case Report


Introduction: Hypertrophic pyloric stenosis (HPS) is well known in pediatric surgery and has good outcomes after pyloromyotomy.1 Emesis in the immediate postoperative period occurs in 40% of patients with HPS and is attributed to gastroparesis from prolonged gastric distention.2 Emesis presenting weeks to months after pyloromyotomy prompts an evaluation that often yields pathology unrelated to HPS. Because recurrent HPS is rare, making this diagnosis highlighted the importance of practicing broad differential diagnoses, ruling out most common causes, and including obscure etiologies.

Clinical Findings: A 3-week-old male born after full-term gestation with a history of HPS underwent an uncomplicated laparoscopic pyloromyotomy. He had an uneventful initial recovery but then presented with recurrent projectile nonbilious emesis 7 weeks postoperatively. Between presentations, the patient consistently tolerated feeds and gained weight. Informed consent was obtained.

Clinical Course: The patient was evaluated with an abdominal ultrasound, which revealed a hypertrophic pyloric channel, and an upper gastrointestinal contrast (UGI) study, which showed a partial gastric outlet obstruction. He underwent laparoscopy, which revealed a thickened pyloric channel, prompting a repeat pyloromyotomy. Postoperatively, his diet was advanced, and he was discharged on postoperative day 1.

Conclusions: Emesis after pyloromyotomy for HPS is common and usually self-limited. Recurrent emesis after normal feeding for weeks or months often yields a diagnosis unrelated to HPS. However, if other more common causes of emesis are excluded, then recurrent HPS can be evaluated with abdominal ultrasound and an UGI study. Once diagnosed, laparoscopic repeat pyloromyotomy is an appropriate treatment option.



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