An unusual presentation of infantile hypertrophic pyloric stenosis with severe late-onset neonatal sepsis

A 27 days old neonate presented with poor feeding, severe respiratory distress and septic shock without any palpable abdominal mass. On evaluation found to have features of overt late onset neonatal sepsis and right sided pneumonia. The initial working diagnosis was poorly resolving pneumonia however upon further evaluation found to have blood gas and ultrasonographic evidence of infantile hypertrophic pyloric stenosis (IHPS). Good perioperative care is required to prevent complications.