Congenital hypertrophic pyloric stenosis-a rare presentation of a common entity

A newborn male baby was referred to our institute on day 2 of life with history of persistent projectile non-bilious vomiting since birth. The baby was full term and was born by normal vaginal delivery. There was no history suggestive of pyloric stenosis in the family. Nor was there any maternal exposure to macrolides or smoking. The possibility of mal rotation was considered. We investigated the neonate with contrast study and ultrasound which were consistent with hypertrophic pyloric stenosis. The muscle thickness was 5mm and the pyloric length was 14mm. Upper gastro-intestinal contrast study demonstrated a dilated stomach with string sign and shouldering of the pyloric muscle. The blood gas showed severe alkalosis. We did not perform gastrin levels. He was operated on day 3 of life after correction of electrolytes and alkalosis. Open Ramstad’s pyloromyotomy was performed. Postoperative recovery was uneventful. Feeds were started after 24 hours and the neonate was