Many pyloric stenosis cases don’t go to the operating room.
Despite years of scanning the mass of information and reports available on the Web, I have never seen a set of statistics on the percentage of Pyloric Stenosis (“PS”) babies who are operated on to save them from wasting to death. From what I’ve been able to find, there have been many studies on aspects of PS, but never on how many cases are “mild” enough not to go to surgery.
So I can only quote my personal experience as some sort of indication.
Two of the first four PS survivors I came to know did not have surgery and the other two did. Of course it’s well-known that statistics can mislead. The fact that the two guys who had surgery also had a scar similar to mine was probably quite normal when all three of us were much younger, but even then it was certainly not representative in the USA. The vertical midline approach to a troublesome pylorus muscle used to be quite common in many countries, but in recent years it is hardly ever used for various interesting reasons.
More indicatively, since that dawning of my awareness that I was not the only person on the planet to have had surgery that I couldn’t remember (how naïve we all were once!), and that there were others who’d struggled with PS but without surgery, I have met and read of many others whose PS was not life-threatening enough to risk surgery.
Untreated pyloric stenosis doesn’t always kill but it can niggle
There are many stories “out there” of babies, children, teenagers and young adults who continue to have many of the symptoms of a mild form of PS. Some of them wonder if surgery might relieve them of their troublesome stomach problems. Others have chosen (or needed) in later years to have their pyloromyotomy to get relief from continuing stomach trouble.
On the basis of the accounts of so many parents, it is clear that some if not many parents and babies never quite reach the point where the defective stomach valve is actually threatening the very life of the baby enough for somebody in the health care industry to agree to the necessary checks and tests. So the vomiting, deeply frustrating feeding and retarded growth continue on over months or sometimes years. It seems many babies but not all grow out of untreated PS during infancy.
Sometimes the cause of a baby’s reflux and severe vomiting is not PS at all but an irritable bowel or severe reflux, neither of which cause weight-loss and a deadly loss of wellness. The cause may also be another, less common but perhaps just as deadly a malady of the gastric passage or another abdominal organ.
Not all pyloric stenosis is actually diagnosed.
In several recent posts I have reported the frustration of parents about the reluctance, even the refusal of many pediatricians to test their baby for what they were sure was PS or another serious condition of infancy. Tests take time and money, baby blues can be caused by any of several possible problems, and too many doctors are inclined to brush new parents off as over-fussy or ill-informed, perhaps to await how the problem develops, or perhaps simply because they want to move on to the next patient.
PS is too often ignored and left undiagnosed until the baby’s life is in severe danger, obviously so to the family and it seems often recognised as such by medical staff members who were not directly responsible for the tardy diagnosis. Because of this, there will be many milder cases that escape medical diagnosis and the knife.
This is really a subject in its own right. In historically Caucasian countries with developed economies, the medical treatment of PS with atropine sulphate is usually given scant consideration. I will explain and discuss the reasons for this in another post soon.
Atropine treatment is a muscle relaxant that allows the pyloric muscle to open and shut without surgical intervention, but because of its effect on muscles it must be introduced over several days and under careful medical supervision. This atropine treatment has been used for many years by a small minority of pediatric specialists in many countries, and a recent Japanese project found its use succeeded in avoiding surgery in almost every case in the trial.
Parents who 1) know the symptoms of PS well, 2) have gathered strong set of evidences of their baby’s condition and perhaps have previous experience with this malady, and 3) whose baby is not close to death may well consider seeking medical treatment for their much-treasured and still near-perfect recent arrival. It must be realised that the safe use of atropine sulphate medication requires early diagnosis and a baby whose condition allows the several days necessary for the drug to have sufficient effect.
I am not alone in having had significant difficulty coming to terms with infant trauma and my scarred body, especially in my younger years when I was slim, sleek and handsome! Although like many survivors I have now come to embrace my scar as a key part of my survival and life story, I would certainly have opted for first trying a course of medication if I’d had a say in this.