CLINICAL IMAGES Vomiting in a 22-day-old firstborn male

A 22-day-old healthy appearing male infant presented with persistent vomiting after feeding with onset shortly after birth. This is the father’s second child and the mother’s first. Switching formulas had been unsuccessful. Abdominal X-ray (AXR) revealed a dilated air-filled stomach with a nonspecific bowel gas pattern (Fig. 1). Ultrasound (US) demonstrated a thick and elongated pylorus, confirming the diagnosis (Figs. 2 and 3). Pyloric stenosis is an important cause of gastric outlet obstruction and vomiting in infants. Peak incidence occurs between 2 and 5 weeks of age with an incidence of 1–8 per 1,000 live births. Male infants are predominantly affected 4:1 over female infants [1]. There is a familial component, with sons of affected fathers carrying a 5 % risk of pyloric stenosis [2].