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December 2013

Beyond the Firstborn Son: Epidemiology to Enlighten the Pathogenesis of Hypertrophic Pyloric Stenosis

Author Affiliations
  • 1Division of Pediatric Surgery, University of Utah, Salt Lake City
JAMA Pediatr. 2013;167(12):1100-1101. doi:10.1001/jamapediatrics.2013.3899

Infantile hypertrophic pyloric stenosis is a long-trusted friend of the pediatrician and pediatric surgeon. The presentation of this disease is predictable, with development of progressive, projectile, nonbilious vomiting in a 2- to 6-week-old otherwise healthy infant. Most often it occurs in boys and firstborns, with white individuals being at increased risk. The diagnosis is easily confirmed by either physical examination or ultrasonography. The associated hypochloremic, hypokalemic, metabolic alkalosis is sufficiently characteristic that it predictably appears on medical school and board examinations. The preoperative fluid resuscitation is well known and used to teach medical students basic renal physiology. Most importantly, a brief operation (performed either laparoscopically or through a limited incision) returns a healthy infant to the arms of the relieved, new parents.1 What more could one ask for from a disease?