Non-bilious vomiting in a less than two month old infant is a well recognized presentation of Hypertrophic Pyloric Stenosis (HPS). While it has been shown that such persistence of acid regurgitation can result in endoscopically significant esophagitis, frank hematemesis is not usually reported. We retrospectively looked at all infants who were referred to a regional pediatric gastroenterology center for regurgitation presenting before two months of age to establish the frequency of hematemesis in this population. The rate of HPS in this population was also defined.

Chart Review: During an 18 month period, 84 infants less than 2 months of age were referred for unexplained regurgitation. None were found to have metabolic disorders nor central nervous system processes. 7 of these children (8%) gave a history of hematemesis (coffee ground content). 5 of these children (68%) were shown to have HPS by sonography or upper gastrointestinal contrast study and were later confirmed surgically.

Conclusions:

  1. 1

    Hematemesis is relatively uncommon in infants.

  2. 2

    An infant less than 2 months old with hematemesis should have HPS excluded.