Which diagnosis is most likely in a 16-day-old infant with very forceful vomiting after feeds, persistent hunger, and a small epigastric mass?

• A. Achalasia
• B. Tracheoesophageal Fistula
• C. Pyloric Stenosis
• D. Meckel's Diverticulum

Answer: (C)

This vignette highlights hypertrophic pyloric stenosis. When the pyloric muscle thickens, the gastric outlet becomes narrowed, causing nonbilious, forceful vomiting after feeds. The infant often stays hungry because the stomach empties quickly, triggering a cycle of feeding and vomiting. A small, firm epigastric mass—the thickened pylorus, sometimes described as an “olive”—is a classic finding in this condition, and presentation in the first weeks of life (around two to six weeks) fits a 16-day-old well.

Other conditions don’t align with this pattern: achalasia can cause trouble with swallowing and regurgitation but not a palpable pyloric mass in the epigastrium; tracheoesophageal fistula presents with coughing, choking, and drooling during feeds and respiratory distress very early in life; Meckel’s diverticulum typically causes painless lower GI bleeding rather than projectile vomiting or a gastric outlet obstruction with a pyloric mass.