A 3-week-old male infant presents with projectile non-bilious vomiting after every feed, visible gastric peristalsis, and a palpable olive-shaped epigastric mass. Electrolytes show hypochloremic hypokalemic metabolic alkalosis. The definitive treatment is:
- A IV fluid resuscitation with normal saline and KCl until electrolytes are corrected, then Ramstedt's pyloromyotomy ✓
- B Emergency Ramstedt's pyloromyotomy without fluid correction
- C Atropine infusion as the first-line medical treatment to relax the pyloric sphincter
- D Nasogastric drainage and TPN for 2 weeks before surgery
Correct answer: A. IV fluid resuscitation with normal saline and KCl until electrolytes are corrected, then Ramstedt's pyloromyotomy
Explanation
Hypertrophic pyloric stenosis presents with hypochloremic, hypokalemic metabolic alkalosis from loss of gastric HCl; surgery before metabolic correction carries significant anaesthetic risk (paradoxical aciduria, respiratory arrest). Resuscitation with IV 0.9% NaCl with KCl supplementation to correct the alkalosis is mandatory before Ramstedt's pyloromyotomy, which divides the pyloric muscle without entering the mucosa. This is not a surgical emergency; the metabolic correction is the priority, typically achieved in 24-48 hours.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.