Congenital Hypertrophic Pyloric Stenosis · Correct First, then Pyloromyotomy

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Diagnosis (US) + electrolyte status
   Does US meet criteria? Hypochloremic hypokalemic alkalosis? (US criteria: pyloric muscle ≥3–4 mm thick, canal ≥15–17 mm long (diameter ≥10–14 mm). Presentation: age 2–8 weeks, projectile non-bilious vomiting.)
   • US positive + hypochloremic hypokalemic metabolic alkalosis (correct first) → Correct fluids/electrolytes first
   • Fluids/electrolytes already corrected (normal Cl, alkalosis resolved) → After correction → Ramstedt pyloromyotomy
2. [End] Correct fluids/electrolytes first
   Diagnosis established but with hypochloremic hypokalemic metabolic alkalosis → IV fluid resuscitation first (saline + dextrose, add potassium once urine output returns); this is not a surgical emergency and surgery must wait until corrected (Cl >100, HCO3 <30), otherwise anesthetic risk is high (postoperative apnea).
3. [End] After correction → Ramstedt pyloromyotomy
   After fluid/electrolyte correction → pyloromyotomy (Ramstedt, laparoscopic or open); excellent prognosis, gradual postoperative feeding.

Source guidelines & references

• Congenital hypertrophic pyloric stenosis (ultrasound criteria; Ramstedt pyloromyotomy)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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