A 6 year old boy presenting with palpable abdominal mass in the epigastrium. The clinical diagnosis is (There is no bile in vomitus)-

Ans. is 'c' i.e., Pyloric stenosisDiagnosis of congenital hyperophic pyloric stenosis o History of vomiting without bile (nonbilious vomiting).o Physical examination ?i) Palpable mass in the epigastriumii) After feeding, visible gastric peristatic wave that progresses across the abdomen.USG confirm the diagnosis Criteria --> Pyloric thickness > 4 mm or an overall pyloric length > 14 mm.o Contrast studies ?i) Shoulder sign A bulge of the pyloric muscle into the antrum.ii) Double tract sign -> Parallel streaks of barium in the narrowed channel.iii) Elongated pyloric channel.So the boy is having pyloric stenosis. The only problem is age of boy i.e 6 yrs. The hyperophic pyloric stenosis which we know of, makes its clinical presentation in early infancy (3rd to 6th weeks of life)o But the problem in solved once you know that there is a similar disease in adults - Hyperophic pyloric stenosis of adults. (Bailey & Love, 22th/e, p 675).