Presentation
Non-bilious projectile vomiting over the past 4 days
Patient Data
The longitudinal section of the pyloric canal shows a pyloric muscle elongation (25 mm) and the cross section a “target sign”: hypoechoic ring of hypertrophied pyloric muscle (wall thickness=6 mm) around echogenic mucosa centrally.
Photo A: operative view showing the hypertrophied pyloric muscle maintained between index finger and thumb of the surgeon, delimiting the distal end (duodenum).
Photo B: operative view of the pyloromyotomy consisting of a longitudinal incision through the serosa in the avascular area on the anterior surface of the pyloric muscle. Split down of the hypertrophied muscle until will see herniation of mucosa through the incision.
Case Discussion
The universally recommended surgical treatment is Ramstedt pyloromyotomy. Recurrence is usually due to inadequate technique (incomplete Ramstedt pyloromyotomy).
Additional Contributor: D Ouslimane MD, pediatric surgeon.
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