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Idiopathic Hypertrophic Pyloric Stenosis

Idiopathic hypertrophic pyloric stenosis (IHPS) is a common cause of nonbilious, projectile vomiting in the infant. Progressive hypertrophy of the pyloric muscle leads to an obstruction of the gastric outlet. The condition is easily corrected with a pyloromyotomy. Mortality is <0.5% in most specialty centers when hydration and normal electrolyte status is restored prior to surgery, appropriate precautions are taken preoperatively, and the patient is carefully monitored for known postoperative complications. This chapter discusses the related epidemiology and etiology; clinical presentation; use of imaging studies; preoperative preparation; and anesthetic, surgical, nonsurgical, and postoperative management of these patients. Topics covered include metabolic alkalosis, electrolyte abnormality, dehydration, pulmonary aspiration, and pyloromyotomy.