Gastroesophageal Reflux vs. Hypertrophic Pyloric Stenosis
Right picture: According to the history, a hypertrophic pyloric stenosis is clinically the most probable diagnosis. In fact, a pyloric tumor is palpable in the right upper belly, and ultrasound confirms the diagnosis. The traces of fresh blood are not a sequel of a hypertrophic pyloric stenosis, but due to a lesion of the gastric mucous membrane by the tip of the tube; it occurs mostly in premature infants with long term gastric tubes. Left picture: This infant has a complicated gastroesophageal reflux with failure to thrive, and hematin vomiting. The diagnosis was confirmed by pH-metry. An esophagitis should be excluded by esophagoscopy, and a hiatus hernia by an upper gastrointestinal contrast study.
Neither one of these infants looks very happy or would qualify for advertising the products of modern infant alimentation. Left picture: The thin extremities are very striking, as well as the ribs underneath the right axilla. Right picture: This young infant looks unhappy. The gastric tube is indicative of a feeding problem. Left picture: This infant brings up some milk during every feeding or some time afterwards. Also, some distinct vomiting can be observed. Right picture: Vomiting happens under pressure. Within 1 to 2 days, vomiting has increased to a degree that makes feeding impossible. Later some traces of fresh blood are visible in the part of the gastric tube behind the right shoulder. Left picture: Sometimes, the mother observes brownish spots in the bed near the head.