Correct answer:

This is anomalous in that the more seriously ill the child, the less urgent the operation. With prolonged vomiting the infant becomes dehydrated with a hypochloraemic metabolic alkalosis. In such cases a day or two must be spent in gastric lavage and fluid replacement (saline with added potassium chloride), by either the subcutaneous or intravenous route. The otherwise healthy child can be submitted to operation soon after admission. The surgical treatment is Ramstedt’s pyloromyotomy. A longitudinal incision is made through the hypertrophied muscle of the pylorus down to the mucosa and the cut edges are separated. The infant is given glucose water 3 hours after the operation and this is followed by 3 hourly milk feeds, which are steadily increased in amount. Results are excellent and the mortality is extremely low.