<prompt> A 6-year-old boy presenting with a palpable abdominal mass in the epigastrium. The clinical diagnosis is There is no bile in vomitusDuodenal AtresiaCholedochal cystPyloric stenosisOesophageal Atresia  <response>: Diagnosis of congenital hypertrophic pyloric stenosis History of vomiting without bile nonbilious vomiting.Physical examination -Palpable mass in the epigastriumAfter feeding, visible gastric peristaltic wave those progress across the abdomen.USG confirm the diagnosisCriteria Pyloric thickness 4 mm or an overall pyloric length 14 mm.Contrast studies -Shoulder sign A bulge of the pyloric muscle into the antrum.Double tract sign Parallel streaks of barium in the narrowed channel.Elongated pyloric channelSo the boy is having pyloric stenosis. The only problem is the age of boy i.e 6 yrs. The hypertrophic pyloric stenosis which we know of makes its clinical presentation in early infancy 3rd to 6th weeks of lifeBut the problem is solved once you know that there is a similar disease in adults - hypertrophic pyloric stenosis of adults. Bailey Love, 22the, p 675. 