Hypertrofic pyloric stenosis in a premature newborn: case report and brief review

Hypertrofic pyloric stenosis is one of the main causes of non-biliary vomiting in newborn and is typically found between 3 and 4 weeks old babies. It is rarely found in early neonatal period, especially in prematures. The case here reported is a male, premature born with 34 gestational weeks, with 3,180 grams of weight admitted to the neonatal ICU due to respiratory discomfort and prematurity. With 3 days old presented non-biliary vomiting, abdominal distention and difficulty to feed. Radiography demonstrated hyperdistended stomach. Remained symptomatic for the next 48 hours and a contrast study demonstrated slow gastric emptying and pyloric and duodenal narrowing. As the findings suggested duodenal obstruction exploratory laparotomy was indicated. During surgery hypertrofic pyloric stenosis was found with no signs of malrotation or duodenal obstruction. Pyloromiotomy was performed and 12 hours after surgery oral feeding was restarted. Patient presented good outcome, is now with 9 months old, good development and adequate weight gain. As demonstrated, even though it is an unusual cause, hypertrofic pyloric stenosis must be considered as an important differential diagnosis when facing a digestive obstruction in newborn.