Canadian Journal of Anaesthesia

, Volume 38, Issue 5, pp 668–676 | Cite as

Pyloric stenosis

  • Bruno Bissonnette
  • Patrick J. Sullivan
Continuing Medical Education


Infantile pyloric stenosis is the most frequently encountered infant gastrointestinal obstruction in most general hospitals. Although the primary therapy for pyloric stenosis is surgical, it is essential to realize that pyloric stenosis is a medical and not a surgical emergency. Preoperative preparation is the primary factor contributing to the low perioperative complication rates and the necessity to recognize fluid and electrolyte imbalance is the key to successful anaesthetic management. Careful preoperative therapy to correct severe deficits may require several days to ensure safe anaesthesia and surgery. The anaesthetic records of 100 infants with pyloric stenosis were reviewed. Eighty-five per cent of the infants were male (i.e., 5.7:1 male to female ratio) 12% were prematures. Surgical correction was undertaken at an average age of 5.6 wk, and the average weight of the infants at the time of surgery was 4 kg. A clinical diagnosis of pyloric stenosis by history and physical examination alone was made in 73% of the infants presenting to The Hospital for Sick Children. All the infants received general anaesthesia for the surgical procedure and there were no perioperative deaths.

Key words

acid-base equilibrium: acidosis, alkalosis, metabolic anaesthesia: paediatric fluid balance: electrolites, ions intubation: technique surgery: paediatric, pyloric stenosis 


La sténose pylorique demeure la principale cause d’obstruction intestinale survenant chez les bébés. Même si son traitement ultime doit être chirurgical, elle represente d’abord une urgence médicale. Une réanimation préopératoire adéquate est nécessaire afin de prévenir les complications périopératoires et la reconnaissance par l’anesthésiste des perturbations hydroélectrolytiques en est la clef. Il faut souvent passer plusieurs jours à corriger les déficits les plus importants afin d’assurer le succès de l’intervention. Nous avons revu 100 dossiers anesthésiques de pyloromyotomie. On y retrouvait 85% de garçons et 12% de prématurés. L’intervention survenait vers l’âge de 5.6 semaines alors que l’enfant pesait en moyenne 4 kg. Dans 73% des cas, on avait posé le diagnostic sur la base de l’anamnèse et de l’examen physique seulement. On a employé une anesthésie générate dans tous les cas et nous n’avons eu à déplorer aucun décès périopératoire.


  1. 1.
    Daly AM, Conn AW. Anaesthesia for pyloromyotomy: a review. Can Anaesth Soc J 1969; 16: 316–20.PubMedCrossRefGoogle Scholar
  2. 2.
    Grant GA, McAleer JJA. Increasing incidence of infantile hypertrophic pyloric stenosis, 1971–1983. Ir Med J 1986; 79: 118–9.PubMedGoogle Scholar
  3. 3.
    FitzGerald R. Infantile hypertrophic pyloric stenosis. Ir Med J 1986; 79: 112–3.PubMedGoogle Scholar
  4. 4.
    Spicer RD. Infantile pyloric stenosis: a review. Br J Surg 1982; 69: 128–35.PubMedCrossRefGoogle Scholar
  5. 5.
    Katz S, Basel D, Branski D. Prenatal gastric dilatation and infantile hypertrophic pyloric stenosis. J Pediatr Surg 1988; 23: 1021–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Rudolph AM, Hoffman JIE. Pediatrics. Norwalk: Connecticut, 1989.Google Scholar
  7. 7.
    Halperin ML, Goldstein MB. Fluid, Electrolyte and Acidbase Emergencies. 18th ed. Philadelphia: W.B. Saunders Co., 1988.Google Scholar
  8. 8.
    Stringer MD, Brereton RJ. Current management of infantile hypertrophic pyloric stenosis. Br J Hosp Med 1990; 43: 266–72.PubMedGoogle Scholar
  9. 9.
    Steward DJ. Manual of Pediatric Anesthesia. 2nd ed. New York: Churchill-Livingstone Inc., 1985.Google Scholar
  10. 10.
    MacDonald NJ, FitzPatrick GJ, Moore KP, Wren WS, Keenan M. Anaesthesia for congenital hypertrophic pyloric stenosis: a review of 350 patients. Br J Anaesth 1987; 59: 672–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Mackay PJ, MacKellar A. Infantile hypertrophic pyloric stenosis: a review of 222 cases. Aust N Z J Surg 1986; 56: 131–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Sprenger KJ, Berger GMB. The raised anion gap in Banter’s Syndrome. S Afr Med J 1983; 63: 260–5.PubMedGoogle Scholar
  13. 13.
    Touloukian RJ, Higgins E. The spectrum of serum electrolytes in hypertrophic pyloric stenosis. J Pediatr Surg 1983; 18: 394–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Sherman RA, Eisinger RP. The use (and misuse) of urinary sodium and chloride measurements. JAMA 1982; 24: 3121–4.CrossRefGoogle Scholar
  15. 15.
    Rose BD. Clinical Physiology of Acid-base and Electrolyte Disorders. 2nd ed. New York: McGraw-Hill Book Co., 1984.Google Scholar
  16. 16.
    Zeidan B, Wyatt J, Mackensie A, Brereton RJ. Recent results of treatment of infantile hypertrophic pyloric stenosis. Arch Dis Child 1988; 63: 1060–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Woolley MM, Bertram FF, Asch MJ, Carpio N, Isaacs H. Jaundice, hypertrophic pyloric stenosis, and hepatic glucoronyl transferase. J Ped Surg 1974; 9: 359–63.CrossRefGoogle Scholar
  18. 18.
    Leahy PF, Farrell R, O’Donnell B. 300 infants with hypertrophic pyloric stenosis: presentation and outcome. Ir Med J 1986; 79: 117–8.Google Scholar
  19. 19.
    Benson CD. Infantile hypertrophic pyloric stenosis.In: Mustard WT, Ravitch MM, Snydcr WH (Eds.). Pediatric Surgery. Chicago: Year Book Medical Publishers, 1969; 100–23.Google Scholar
  20. 20.
    Benson CD, Lloyd JR. Infantile pyloric stenosis: a review of 1,120 cases. Am J Surg 1964; 107: 429–33.PubMedCrossRefGoogle Scholar
  21. 21.
    Winters RW. Metabolic alkalosis of pyloric stenosis.In: The body fluids in pediatrics. Boston: Little Brown, 1973; 402–14.Google Scholar
  22. 22.
    Todres DI, Firestone S. Neonatal emergencies.In: Ryan JF, Cote CJ, Todres DI, Goudsouzian N (Eds.). A Practice of Anesthesia for Infants and Children. Boston: Grune and Stratton Inc., 1986; 152.Google Scholar
  23. 23.
    Goh DW, Hall SK, Gornall P, Buick RG, Green A, Corkery JJ. Plasma chloride and alkalacmia in pyloric stenosis. Br J Surg 1990; 77: 922–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Hatch DJ, Sumner E. Congenital pyloric stenosis.In: Hatch DJ, Sumner E (Eds.). Neonatal Anaesthesia and Perioperative Care, 2nd ed. London: Edward Arnold Publishers., 1981; 145–7.Google Scholar
  25. 25.
    Kumar V, Bailey WC. Electrolyte and acid base problems in hypertrophic pyloric stenosis in infancy. Ind Pediatr 1975; 12: 839–945.Google Scholar
  26. 26.
    Roizen MF, Sohn YJ, L’Hommedieu CS et al. Operating room temperature prior to surgical draping: effect on patient temperature in recovery room. Anesth Analg 1980; 59: 852–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Mobs RH, Kumar A. Influence of ambient temperature on patient temperature during intraabdominal surgery. Ann Surg 1971; 173: 230–2.CrossRefGoogle Scholar
  28. 28.
    Bissonnette B, Sessler DI. The thcrmorcgulatory threshold in infants and children anesthetized with isoflurane and caudal bupivacaine. Anesthesiology 1990; 73: 1114–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Bissonnette B, Sessler DI. Passive and active inspired gas humidification increases thermal steady-state temperatures in anesthetized infants. Anesth Analg 1989; 69: 783–7.PubMedGoogle Scholar
  30. 30.
    Bissonnette B, Sessler DI, Laflamme P. Intraoperative temperature monitoring sites in infants and children and the effect of inspired gas warming on esophageal temperature. Anesth Analg 1989; 69: 192–6.PubMedGoogle Scholar
  31. 31.
    Steven IM, Alien TH, Sweeney DB. Congenital hypertrophic pyloric stenosis, the anesthetist view. Anaesth Intensive Care 1973; 1: 544–6.PubMedGoogle Scholar
  32. 32.
    Unal D, Bensoussan A, Rigaut F. Anesthdsie-reanimation pour stdnose hypertrophique du pylore. Ann Anesth Fr 1977; XVIII: 1D-5D.Google Scholar
  33. 33.
    Rasmussen L, Hansen LP, Pederson SA. Infantile hypertrophic pyloric stenosis: the changing trend in treatment in a Danish County. J Ped Surg 1987; 22: 953–5.CrossRefGoogle Scholar
  34. 34.
    Dierdorf SF, Krishna G. Anesthetic management of neonatal surgical emergencies. Anesth Analg 1981; 60: 204–15.PubMedCrossRefGoogle Scholar
  35. 35.
    Chatterjee SC, Syed A. Ketamine and infants. Anaesthesia 1983; 38: 1007.PubMedCrossRefGoogle Scholar
  36. 36.
    Bush GH. Ketamine anaesthesia for pyloromyotomy. Anaesthesia 1984; 39: 381.CrossRefGoogle Scholar
  37. 37.
    Bissonnette B, Sessler DI, Laflamme P. Passive and active inspired gas humidification in infants and children. Anesthesiology 1989; 71: 350–4.PubMedCrossRefGoogle Scholar
  38. 38.
    Gregory GA, Steward MB. Life-threatening perioperative apnea in the ex-“prcmic”. Anesthesiology 1983; 59: 495–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Scharli AF, Leditschke JF. Gastric motility after pyloromyotomy in infants: a reappraisal of postoperative feeding. Surgery 1968; 64: 1133–7.PubMedGoogle Scholar
  40. 40.
    Kicely EA, Deasy J, Hart P, Kirwan WO, Brady MP. Congenital hypertrophic pyloric stenosis — a review. Ir Med J 1981; 74: 161–8.Google Scholar
  41. 41.
    Henderson BM, Schubert WK, Hug G, Martin LW. Hypoglycemia with hepatic glycogen depletion: a postoperative complication of pyloric stenosis. J Ped Surg 1968; 3: 309–16.CrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 1991

Authors and Affiliations

  • Bruno Bissonnette
    • 1
  • Patrick J. Sullivan
    • 1
  1. 1.Department of AnaesthesiaThe Hospital for Sick Children, University of TorontoToronto

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