Successful surgery saves the life of a 2-year-old boy with a rare disease

On June 14, 2019, Baby P was admitted to Vinh International Hospital in a state of severe malnutrition, vomiting a lot, even vomiting food from the previous day. The baby's parents were very worried because they had taken the baby to many places for examination but the condition had not improved.

MSCT image of dilated stomach containing a lot of food and folding.

After being examined by a pediatric surgeon, combined with a standing stomach and duodenal X-ray showing a double air bubble image, a stomach and intestinal X-ray with contrast showed that the stomach was dilated to the D2 duodenum, and the contrast still reached the colon. A 128-slice MSCT scan revealed that the patient's stomach was dilated and contained a lot of food, even though the child had fasted since the previous afternoon.

X-ray image of dilated stomach.

Based on clinical and paraclinical examination results, Baby P was diagnosed with incomplete duodenal obstruction due to mucosal septum. The patient was indicated for surgery to release the mucosal septum.

The team of doctors at Vinh International Hospital performed surgery to release the mucosal diaphragm for baby P. Photo: Kim Chung

Due to poor health, before surgery, the baby was treated with electrolyte restoration and nutritional supplements.

On June 21, 2019, the baby's condition improved and surgery was performed. The surgery lasted 60 minutes. Doctors determined that the baby's stomach and duodenum were dilated, removed the duodenal septum, and re-established gastrointestinal circulation.

Image of patient's mucosal diaphragm. Photo: Kim Chung

After 2 days of surgery, the baby was able to eat normally and was discharged after 5 days. To assess the possibility of a complete recovery, the baby was scheduled for a follow-up visit after 1 month.

Duodenal obstruction is a congenital malformation of the digestive tract that completely or partially blocks the duodenum (the first part of the small intestine). The diaphragm located in segment D2 accounts for 85-90% of diaphragm defects.

The cause of this pathology is determined by: The primitive duodenum is a hollow tube from the 4th week of pregnancy, the intercellular plug develops strongly, making the duodenal tube solidify, until the 8th - 10th week of vacuolization occurs, the intercellular plug forms hollow cavities, these hollow cavities then connect with each other to make the duodenum open again. Any defect in the "opening" process will cause the duodenal septum.

Vomiting and bloating are early signs and are reasons for parents to take their children to the doctor. This condition, if prolonged, will cause electrolyte disturbances and malnutrition.

This is a relatively rare disease, accounting for 1/6000 in newborns. Boys are more likely to get the disease than girls and it is often combined with other abnormalities such as: Heart defects, Down syndrome and other gastrointestinal abnormalities.

BSCKI Nguyen Van Tuanwith a lot of experience in Pediatric Surgery, directly performing surgery on baby P said: “Complete duodenal obstruction is a surgical emergency in newborns. If not detected and treated promptly, the child will have gastrointestinal obstruction, vomiting, fluid loss, weight loss, electrolyte imbalance, shock, convulsions and can lead to death.

With incomplete duodenal obstruction in the neonatal period and before weaning, children may vomit more than normal children. However, when weaning age onwards, the occurrence of vomiting after eating increases in number and quantity, the abdomen is distended in the epigastric region, at this time the child grows slowly, is malnourished, stunted and exhausted.

Mothers should have a comprehensive ultrasound in the last 3 months of pregnancy to screen and intervene early for the baby right after birth."