Functional Causes (Vomiting)

Synopsis of the more important functional causes of vomiting which may play a role in the differential diagnosis of hypertrophic pyloric stenosis. Looking at the preferred age of hypertrophic pyloric stenosis, rumination is less important because this disorder of behavior is not observed before the second half of infancy and may be recognized as such by careful clinical observation. More important are the evening or 'three months' colic, the pyloric spasm, and the antral dysmotility disorder. Young infants with the former disorder are admitted due to vomiting following feeding and abdominal pain with the suspected diagnosis 'hypertrophic pyloric stenosis' by mistake; a precise history and the observation of feeding often permits the diagnosis of evening colic. The diagnosis 'pyloric spasm' is used if the x-ray (ultrasound or esophago-gastrography) shows no obvious signs of a hypertrophic pyloric stenosis and a non-operative treatment cures the disease. Nevertheless, it is important to know a) that the clinical signs may precede the positive radiological signs and b) that in spite of a hypertrophic pyloric stenosis partial feeding may be possible. $$regu_1??££ See alternate picture§§ . Therefore, the negative ultrasound should be repeated or should be performed anyway for safety reasons. The antral dysmotility disorder plays an important role in the evaluation of a gastroesophageal reflux; the work-up may also be performed with isotopes instead of contrast. In case of failure of non-operative treatment of reflux or during fundoplication, a combined pyloroplasty may be useful.