Right out of ‘the exorcist’: Pyloric stenosis

Case presentation

A 3-week-old male presents with nonbilious, nonbloody emesis for the past 1.5 weeks. Initially there were two to three episodes per day, occasionally with feeding, but this has increased to emesis with every feed. The parents report that the emesis is “forceful” and afterward the child appears to want to eat again. He has had decreased urine output over the past 24 hours. There has been no fever, diarrhea, or known trauma. He has been increasingly fussy for the past several days. He has an unremarkable medical history and was born “full term.”

Physical examination reveals an afebrile child with a heart rate of 130 beats per minute, respiratory rate of 40 breaths per minute, and a blood pressure of 84/60 mm Hg. The baby is fussy but consoles as he eagerly takes a pacifier. Mucous membranes are slightly dry, but the physical examination is otherwise normal

Imaging considerations