'Burned out' pyloric stenosis: an elusive gastric outlet obstruction

Four cases of infantile pyloric stenosis are presented to illustrate the difficulties found in diagnosing pyloric stenosis. Clinical, histological, surgical, and roentgenologic examination must be combined to determine the optimum treatment. All patients exhibited failure to thrive and gain weight normally, but few showed palpable tumors upon abdominal examination. The results of upper gastrointestinal examination are often more confusing than helpful, but previously performed GI studies have been rewarding. The main problem is to rule out pylorospasm, and a trial of treatment with antispasmodics is essential. The presence or absence of a residual muscle mass at surgery would call for pylorotomy or pyroplasty, respectively.