A 6-week-old male infant presents with projectile non-bilious vomiting after every feed. Examination reveals a palpable olive-shaped mass in the right hypochondrium. Ultrasound confirms pyloric muscle thickness of 4.5 mm and canal length of 18 mm. The definitive treatment is:

• A Pyloromyotomy (Ramstedt's procedure) after correction of electrolyte abnormalities ✓
• B Nasogastric feeding with metoclopramide for 2 weeks then reassess
• C Atropine sulphate IV followed by oral atropine if response seen
• D Endoscopic balloon dilatation of the pylorus

Explanation

Hypertrophic pyloric stenosis causes hypochloraemic, hypokalaemic metabolic alkalosis due to loss of HCl in vomit. Diagnosis is confirmed by ultrasound (muscle thickness >3 mm, canal length >14 mm). Surgery is NOT an emergency — the priority is correcting electrolytes and metabolic alkalosis with IV 0.45% saline with dextrose and KCl before proceeding to Ramstedt's pyloromyotomy (longitudinal incision through the pyloric muscle without entering the mucosa). The vomiting resolves within 24–48 hours post-surgery.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.