ABSTRACT
This chapter focuses on a 5-week-old boy who suspects pyloric stenosis. One would expect this child to present looking dehydrated. His mother may give a history of his initially feeding well but now vomiting in a projectile manner after each feed. As the mother feeds the child, palpate the abdomen for the 'olive'-sized pylorus which is palpable in 50% of cases. The diagnosis can be confirmed on ultrasound detection of an increased pyloric diameter and length. The patient is likely to have a hypokalaemic, hypochloraemic metabolic alkalosis because of the loss of gastric fluids. This is corrected with intravenous dextrose–saline and potassium. When the dehydration has been corrected, obtain consent to perform a Ramstedt's pyloromyotomy. This operation is performed under general anaesthetic. A 3–4 cm transverse incision is made in the right upper quadrant over the palpable pyloric tumour and advanced through the right rectus muscle down to peritoneum.
