Hypertrophic pyloric stenosis in a 15-year-old male

We present the case of a fifteen-year-old male with hypertrophic pyloric stenosis (HPS) thought to have originated in early infancy when chronic non-bilious emesis, early satiety and failure to thrive were evident. He developed two episodes of perforated pre-pyloric ulcer at ages 12- and 14-years. Work up for chronic Helicobacter pylori and Zollinger Ellison syndrome were negative. An upper GI study revealed a massively enlarged stomach and delayed gastric emptying. Endoscopic ultrasound revealed a thickened pylorus and a narrow pyloric canal. Electrogastrogram and antroduodenal motility studies supported a mechanical gastric outlet obstruction. A distal gastrectomy with Billroth I reconstruction was performed. One year after surgery, the patient's symptoms resolved and he had gained 14.5 kg in weight. This is a very rare case of HPS presenting after infancy and emphasizes the importance of early diagnosis of HPS to prevent long term complications including failure to thrive and death.