Dramatic rescue of a perforated stomach case with intestinal malrotation in a premature, low birth weight infant at Hai Phong International Obstetrics and Pediatrics Hospital.
Neonatal gastric perforation is a rare condition; however, the mortality rate is very high, ranging from 20 to 40% depending on the treatment centers. The condition was described as early as 1825 by the scientist Siebold. There are many risk factors for the disease, among which are premature and low birth weight infants, congenital intestinal obstruction diseases, and deficiency of the muscular layer of the stomach are often mentioned. The disease typically presents clinically between the second and fifth day after birth.
The patient TNA from Thuy Nguyen experienced preterm labor at 35 weeks of gestation. The baby was born weighing 2300g and was stable. However, by the next day after birth, the baby showed signs of enteritis: excessive vomiting, bloody gastric fluid, and was treated in the neonatal intensive care unit. By the fourth day after birth, the infant’s condition worsened, with pale lips, cyanotic skin, difficulty breathing, abdominal distension, red and swollen abdominal wall, and blood oxygen levels below 85%. It was assessed as a case of septic shock, with signs of surgical abdominal pathology, prompting the hospital to conduct an interdisciplinary consultation involving: Neonatal Intensive Care, Pediatric Surgery, and Anesthesia. After the consultation, the infant was diagnosed with peritonitis and neonatal intestinal obstruction in a low birth weight preterm infant, showing signs of septic shock, with a high risk of mortality, requiring both intensive resuscitation and emergency surgery. Under the direction of Dr. Pham Thu Xanh – Executive Director of the hospital, with all determination, focusing all human and material resources to save the infant, the patient was immediately transferred to the operating room along with the doctors from the neonatal intensive care unit and the surgical team.
pediatric surgery, performing emergency surgery.
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- TS.BSCKII Phạm Thu Xanh – Giám đốc điều hành Bệnh viện Quốc tế Sản Nhi Hải Phòng thăm bệnh nhi tại Khoa Hồi sức cấp cứu-sơ sinh.
The surgical team consists of personnel from the Pediatric Surgery Department, the Anesthesia and Resuscitation Department, and the Neonatal Intensive Care Unit. During the surgery, the surgical team discovered that the patient had a condition of intestinal malrotation, with necrosis of the posterior stomach wall, which had perforated over a length of 2-3 cm along the greater curvature of the stomach. Following the ruptured area of the stomach was a region of the stomach wall lacking the muscularis layer, along with the patient having additional abnormalities of midgut malrotation. The condition of gastric wall necrosis was assessed to be due to the malrotation of the intestine caused by the congenital absence of the muscularis layer in the stomach wall, combined with the patient’s weak condition. The surgical team decided to resect the abnormal ligaments causing intestinal obstruction and gastric distension; to reposition the intestines to improve blood supply and ensure patency for the digestive tract; to excise the necrotic area, suture the stomach wall; to fold the area lacking the muscularis layer, eliminating the possibility of gastric re-necrosis, and finally to clean the abdominal cavity, place a drain, and close the abdominal wall. The surgery lasted for 1 hour and 25 minutes.
Postoperatively, the patient was transferred totreatment at the Neonatal Intensive Care Unit. The patient was on a ventilator, received inotropic support, and was completely parenterally fed…
Four days after surgery, the patient had the endotracheal tube removed and was weaned off the ventilator; on the sixth day post-surgery, feeding with gradual increases in milk was started. Eighteen days after surgery, the patient was breastfeeding well and was discharged with stable condition, having gained 500 grams.
On the day of discharge, the joy was overwhelming in the eyes of the child’s family along with the entire surgical, anesthetic, and intensive care team. The complete success of this case marked a new milestone in the development of surgical expertise in particular and pediatric expertise at Hai Phong International Obstetrics and Pediatrics Hospital in general.
It is hoped that with daily training, development, and enhancement of professional skills, along with heartfelt service and care, Hai Phong International Obstetrics and Pediatrics Hospital will always be a trusted destination for parents in their journey to protect and care for their children’s health.
