Question

In congenital hypertrophic pyloric stenosis, the abdominal mass is best demonstrated:

• A. On palpation over the epigastrium
• B. In the left hypochondrium
• C. During feeding
• D. In the right iliac fossa

Hint:

Think of the test feed, when the relaxed infant lets you feel the olive.

Answer 1

The Correct Option is C

Step 1: Congenital hypertrophic pyloric stenosis presents around 3 to 6 weeks of age, classically in a first-born male, with non-bilious projectile vomiting after feeds. The hypertrophied pyloric muscle forms a firm, olive-shaped lump in the epigastrium.
Step 2: The standard bedside method to demonstrate the mass is the test feed. The infant is fed milk from a bottle while the surgeon palpates the relaxed abdomen with a warm hand. As the stomach fills and the baby settles, the pyloric olive becomes easiest to feel and visible peristaltic waves cross the upper abdomen. Hence the mass is best demonstrated during feeding.
Step 3: Why the other options are weaker. Simply palpating over the epigastrium without a feed often misses the small lump because the crying, tense infant guards the abdomen. The left hypochondrium and the right iliac fossa are wrong anatomical sites - the pylorus lies in the epigastrium toward the right upper quadrant, not in the iliac fossa. Ultrasonography is the investigation of choice for confirmation.