Hypertrophic Pyloric Stenosis vs. Incidental Finding

Left picture: The cause of the black splashes is not a melena like the stool in the picture at the bottom with loss of blood by the anus (notice the red halo), but a so-called starvation stool; a starvation stool may be observed in infants with hypertrophic pyloric stenosis if no regular feeding is possible. Notice the green halo of the seemingly black stool splashes, which means that it is not dark blood, and that the intestinal passage is functioning from the site of the entrance of bile in the duodenum. Right picture: The grey stool is not caused by a biliary atresia or another hepatobiliary pathology, and the yellow halo in the stool portion at the bottom is due to normal yellow urine. The parents mention that the patient is artificially fed with a hypoallergenic milk, although a cow milk or other type of allergy has not been proved. This type of milk explains the observed type of stool specimen.

Left picture: Textile diaper of a young infant with black splashes of stool. The child has had projectile vomiting since several days ago. Right picture: Paper diaper in a young infant who is not breast fed. The patient brings up some milk after every feeding. Left picture: Feeding of the infant is nearly impossible, and the patient has lost weight. Right picture: The consultation did not take place because of the bringing up of milk, but because of a slight disconfiguration of the skull which cannot be associated with a craniosynostosis. The grey and pasty stool with a yellow halo of the portion at the bottom was observed incidentally when the diaper was changed. The infant has a good general condition, the belly is inconspicuous, and no icterus is present.