A 3-week-old male infant presents with projectile non-bilious vomiting after feeds, palpable olive-shaped mass in the epigastrium, and hypochloraemic hypokalaemic metabolic alkalosis. What is the definitive surgical treatment?
- A Pyloromyotomy (Ramstedt's operation) after correction of electrolyte abnormalities ✓
- B Emergency laparotomy and pyloroplasty
- C Endoscopic balloon dilatation of the pylorus
- D IV atropine for 5-7 days to relax pyloric spasm
Correct answer: A. Pyloromyotomy (Ramstedt's operation) after correction of electrolyte abnormalities
Explanation
Infantile hypertrophic pyloric stenosis is treated by Ramstedt's pyloromyotomy — splitting the hypertrophied pyloric muscle longitudinally without entering the mucosa — after adequate correction of the hypochloraemic hypokalaemic metabolic alkalosis (typically with 0.45% NaCl + 20 mmol/L KCl infusion). Surgery must not be performed until the electrolyte abnormalities are corrected, as metabolic alkalosis impairs ventilation by dampening respiratory drive. IV atropine (medical pyloromyotomy) is an alternative in resource-limited settings but is not first-line.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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