Abstract
A 24-day old female Nigerian neonate presented with protracted vomiting, fever and dehydration but without palpable abdominal tumour or visible gastric peristalsis. There was no derangement of serum electrolytes. The initial working diagnosis was Late-Onset Sepsis but abdominal ultrasonography showed features consistent with the diagnosis of IHPS. This case report highlights the atypical presentation of this surgical condition and the need to investigate cases of protracted vomiting in the newborn with at least, ultrasonography to minimize complications and reduce the risk of mortality in a resource-poor setting.
Highlights
Vomiting, in the newborn, frequently connotes physiologic events such as feed regurgitation or poor positioning after over-feeding and less commonly, follows serious illnesses such as asphyxia, sepsis, necrotizing enterocolitis, in-born errors of metabolism or upper gastrointestinal obstructive lesions [1]
The typical “doughnut-shaped” appearance of the gastric shadow in transverse abdominal scan was seen. These findings are consistent with the diagnosis of Infantile Hypertrophic Pyloric Stenosis
Pyloromyotomy (Figure 2) was done and the baby did well post operatively. She was discharged home on the 5th post-operative day without complications. This case report aims at highlighting the diagnostic challenges which may be encountered in Infantile hypertrophic pyloric stenosis (IHPS)
Summary
In the newborn, frequently connotes physiologic events such as feed regurgitation or poor positioning after over-feeding and less commonly, follows serious illnesses such as asphyxia, sepsis, necrotizing enterocolitis, in-born errors of metabolism or upper gastrointestinal obstructive lesions [1]. Infantile hypertrophic pyloric stenosis (IHPS) is one of the surgical causes of protracted vomiting in early infancy. This condition is characterized by abnormal thickening of the muscular wall of the pylorus it is the commonest cause of gastric outlet obstruction in infancy. Apart from scanty urinary output, the baby presented with no other symptoms This infant was the first child of her mother - a 30-year old second wife, known epileptic. The typical “doughnut-shaped” appearance of the gastric shadow in transverse abdominal scan was seen These findings are consistent with the diagnosis of Infantile Hypertrophic Pyloric Stenosis. She was discharged home on the 5th post-operative day without complications
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