Question:
A 4-week-old male infant presents with progressively worsening non-bilious projectile vomiting, post-feed hunger, and visible left-to-right gastric peristalsis. What is the most likely diagnosis?
A 4-week-old male infant presents with progressively worsening non-bilious projectile vomiting, post-feed hunger, and visible left-to-right gastric peristalsis. What is the most likely diagnosis?
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IHPS classic metabolic derangement: Hypochloremic, hypokalemic metabolic alkalosis (due to loss of HCl in gastric fluid).
Always correct the electrolytes and fluid status completely before proceeding to the definitive surgical repair (Ramstedt pyloromyotomy).
Always correct the electrolytes and fluid status completely before proceeding to the definitive surgical repair (Ramstedt pyloromyotomy).
Updated On: Sep 3, 2026
- Duodenal atresia
- Infantile hypertrophic pyloric stenosis (IHPS)
- Malrotation with volvulus
- Gastro-oesophageal reflux (GOR)
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The Correct Option is B
Solution and Explanation
Concept:
The clinical presentation provides a textbook triad for a specific neonatal gastrointestinal obstruction.
The clinician must differentiate the level and type of bowel obstruction based on the nature of the vomitus and the physical findings.
Explanation:
• The infant presents at the classic age of 3 to 6 weeks with vomiting that is specifically described as non-bilious and projectile.
• Non-bilious vomiting indicates that the physical obstruction is located proximal to the Ampulla of Vater in the duodenum.
• This is the hallmark of Infantile Hypertrophic Pyloric Stenosis (IHPS), where the pyloric muscle becomes severely thickened, creating a gastric outlet obstruction.
• Because the infant is starving but structurally unable to pass food, they exhibit intense post-feed hunger ("the hungry vomiter").
• The stomach hypertrophies in an attempt to push food through the tight pylorus, resulting in visible left-to-right gastric peristaltic waves sweeping across the upper abdomen.
• Duodenal atresia and Malrotation with volvulus cause obstruction distal to the ampulla of Vater, thus presenting with green, bilious vomiting, which is a surgical emergency.
• Gastro-oesophageal reflux (GOR) causes effortless regurgitation ("spitting up"), not forceful projectile vomiting with progressive obstruction and hunger.
Final Answer:
The triad of non-bilious projectile vomiting, post-feed hunger, and visible gastric peristalsis in a 4-week-old is pathognomonic for Infantile hypertrophic pyloric stenosis (IHPS).
The clinical presentation provides a textbook triad for a specific neonatal gastrointestinal obstruction.
The clinician must differentiate the level and type of bowel obstruction based on the nature of the vomitus and the physical findings.
Explanation:
• The infant presents at the classic age of 3 to 6 weeks with vomiting that is specifically described as non-bilious and projectile.
• Non-bilious vomiting indicates that the physical obstruction is located proximal to the Ampulla of Vater in the duodenum.
• This is the hallmark of Infantile Hypertrophic Pyloric Stenosis (IHPS), where the pyloric muscle becomes severely thickened, creating a gastric outlet obstruction.
• Because the infant is starving but structurally unable to pass food, they exhibit intense post-feed hunger ("the hungry vomiter").
• The stomach hypertrophies in an attempt to push food through the tight pylorus, resulting in visible left-to-right gastric peristaltic waves sweeping across the upper abdomen.
• Duodenal atresia and Malrotation with volvulus cause obstruction distal to the ampulla of Vater, thus presenting with green, bilious vomiting, which is a surgical emergency.
• Gastro-oesophageal reflux (GOR) causes effortless regurgitation ("spitting up"), not forceful projectile vomiting with progressive obstruction and hunger.
Final Answer:
The triad of non-bilious projectile vomiting, post-feed hunger, and visible gastric peristalsis in a 4-week-old is pathognomonic for Infantile hypertrophic pyloric stenosis (IHPS).
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