Biography
Biography: Dr.Muhammad ali
Abstract
Background:
We are reporting a case of pyloric stenosis in an extremely preterm male baby of 27 weeks gestation, discovered in the 7th week of life. To our knowledge, pyloric stenosis has not been reported previously in a preterm baby of 27 weeks of gestation or less.
The presentation of pyloric stenosis in preterm babies is atypical and diagnosis is often delayed.
Case Presentation:
A male baby was born via vaginal delivery at 27 weeks. He had smooth neonatal journey requiring respiratory support.
His feeds were commenced and built up with preterm formula according to local guidelines. He reached full feeds on day 10.
On day 13, he showed signs of feed intolerance with vomiting and distended abdomen. He was treated for suspected sepsis and septic ileus.
On day 44 (33+1 CGA), he developed persistent vomiting. Several management strategies were tried including nasogastric tube replacement, gravity feeding and decreasing feed volume.
He continued to be clinically well with normal abdominal examination.
On day 45, he was placed NBM and treated for possible NEC.
His blood gas at that time showed pH 7.4, CO2 8.7, HCO3 36.6, BE 16.3,Na 138 , K 3.2 ,Cl 92
Investigations:
His D45 plain Abdominal film showed non-specific bowel gas pattern, dilated stomach bubble but no signs of NEC (Fig:1) and abdominal ultrasound showed appearances in keeping with pyloric stenosis. The pyloric muscle was thickened with pyloric length of 1.9 cm muscle thickness of 4 mm (Fig:2).
Treatment:
He underwent pyloromyotomy and recovered fully afterwards.
Discussion:
The blood gas did show the textbook hypokalaemic hypochloraemic metabolic alkalosis although more subtly than usually described.
• Pyloric stenosis should remain a differential diagnosis in preterm neonates with persistent vomiting and feed intolerance.
• A contrast study may be needed in order to confirm diagnosis if ultrasound findings remain inconclusive