management
Last reviewed 01/2018
The first aim in management of adult pyloric stenosis is resuscitation of the patient. This involves correcting any electrolyte imbalances that have occurred as the result of persistent vomiting. Note that the urea will normally fall as a result of rehydration and that this intervention may unmask a chronic anaemia. The latter may require blood transfusion.
Food residues must be removed from the stomach. This may take several days administration of weak bicarbonate solution into the stomach via a large bore oesophageal tube. H2-antagonists or a proton pump inhibitor are also given at this stage to reduce any inflammatory process.
The corrective treatment of adult pyloric stenosis is surgical. There are several options but an often used technique is a truncal vagotomy with a pyloroplasty or gastroenterostomy. Proximal gastric vagotomy and stricture dilatation has also been attempted.