A 3-week-old first-born male infant presents with forceful non-bilious projectile vomiting after every feed. He is ravenously hungry immediately following emesis. On physical examination, a mobile olive-sized mass is palpated in the right epigastrium. What is the diagnosis?

Answer and explanation

Correct answer: D. Infantile hypertrophic pyloric stenosis

  1. Step 1: Hypertrophic pyloric stenosis is characterized by hypertrophy of the circular pyloric smooth muscle.
  2. Step 2: It presents between 2 and 8 weeks of life with progressive non-bilious projectile vomiting, persistent hunger, dehydration, and a palpable 'pyloric olive' in the epigastrium.
  3. Step 3: Metabolic profile typically reveals hypochloremic, hypokalemic metabolic alkalosis.
Answer
Infantile hypertrophic pyloric stenosis.
Why not the others: 'GERD' causes effortless regurgitation without projectile vomiting or a palpable olive mass; 'Duodenal atresia' presents in the first 24-48 hours of life with bilious vomiting and a 'double-bubble' sign; 'Midgut volvulus' presents with acute bilious emesis and abdominal distention.

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