Abstract
Background: Infantile hypertrophic pyloric stenosis (IHPS) is an exceedingly rare cause of postoperative emesis in a case of hiatal hernia. Occasionally it may simulate other etiology of gastric outlet obstruction. Case Presentation: A 32-day-old male baby presented with respiratory distress and vomiting since birth. Diagnosis of eventration of left hemi diaphragm was made on CT Chest. At surgery, hiatal hernia with an intrathoracic stomach was found, which was repaired. On 5th postoperative day, the baby developed vomiting after feeding which gradually turned to be projectile in nature over a week. Contrast meal performed showed malpositioned stomach with delayed emptying. At re-operation, a well-formed olive of pylorus was encountered; Ramstedt pyloromyotomy was done. Postoperative course remained uneventful. Conclusion: IHPS is a rarely described association with hiatal hernia. Pyloric stenosis should be considered in differential diagnoses of postoperative emesis in infants with hiatal hernia.
Highlights
Hiatal hernia (HH) is characterized by gastric herniation to the chest through a widened esophageal hiatus
Pyloric stenosis should be considered in differential diagnoses of postoperative emesis in infants with hiatal hernia
Gastroesophageal reflux (GER), and recurrent chest infections secondary to aspiration etc., are various indications of HH repair.(1) HH is repaired with and without addition of fundoplication.(2) Postoperative emesis in a case of HH especially treated without fundoplication is attributed to gastroesophageal reflux (GER), though projectile nonbilious emesis is a characteristic of gastric outlet obstruction.(2) Infantile hypertrophic pyloric stenosis is a well-known etiology of projectile nonbilious vomiting in early infancy
Summary
IHPS is a rarely described association with hiatal hernia. Pyloric stenosis should be considered in differential diagnoses of postoperative emesis in infants with hiatal hernia.
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