Hypertrophic pyloric stenosis

Case contributed by Abdulmajid Bawazeer
Diagnosis certain


Projectile vomiting and poor feeding. Failure to thrive.

Patient Data

Age: 2 weeks
Gender: Male

The patient was examined in the oblique position for better visualization of the pyloric canal after feeding.
The pyloric canal was measured in different planes as:

  • pyloric muscle thickness: about 0.5 cm
  • length: 2.35 cm
  • pyloric transverse diameter: 1.45 cm

 The stomach was distended.

Case Discussion

Hypertrophic pyloric canal stenosis should be suspected in the first weeks if the neonate presents with projectile vomiting and poor feeding.

Ultrasound is the best modality to assess the pylorus. The exam is performed after a copious meal (milk) to distend the stomach and allow a good sonographic window to visualize the pylorus.

Pylorospasm may mimic pyloric canal stenosis on imaging, so follow up and clinical correlation may be helpful if this is suspected. Transient pylorospasm should not present with the classic clinical features of pyloric canal stenosis.

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