Successful surgery saves the life of a 2-year-old boy with a rare medical condition.
(Baonghean.vn) - HMP, a child from Nghi Hung commune (Nghi Loc district, Nghe An province), weighs only 7kg despite being 25 months old. The child has been frequently vomiting since birth, and the condition worsened when the child started eating solid foods and gradually transitioned to solid foods. Although the parents have taken the child to many doctors, the cause remains unknown.
On June 14, 2019, Baby P was admitted to Vinh International Hospital in a state of severe malnutrition, experiencing frequent vomiting, even vomiting up food from the previous day. Her parents were very worried because they had taken her to many doctors, but her condition had not improved.
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| MSCT scan images show a greatly dilated stomach containing a large amount of food and exhibiting kinks. |
After examination by a pediatric surgeon, combined with a standing gastroduodenal X-ray showing double air bubbles, and a contrast-enhanced gastroenterogram revealing gastric dilation extending to the D2 segment of the duodenum, with the contrast medium reaching the colon, a 128-slice MSCT scan showed the child's stomach was significantly distended and contained a large amount of food, despite the child having fasted since the previous afternoon.
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| X-ray image showing a greatly dilated stomach. |
Based on clinical and paraclinical examination results, Baby P was diagnosed with incomplete duodenal obstruction due to a mucosal membrane. The patient was scheduled for surgery to release the mucosal membrane.
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| The team of doctors at Vinh International Hospital performed surgery to release the mucosal membrane for baby P. Photo: Kim Chung |
Due to her weak condition, the child received electrolyte replacement and nutritional support before surgery.
On June 21, 2019, the child's condition improved and surgery was performed. The operation lasted 60 minutes, during which doctors determined that the child's stomach and duodenum were greatly distended. They proceeded to remove the duodenal membrane and restore the continuity of the digestive tract.
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| Image of the patient's mucosal membrane. Photo: Kim Chung |
Two days after the surgery, the child was able to eat and drink normally and was discharged after five days. To assess the extent of complete recovery, a follow-up appointment was scheduled after one month.
Duodenal obstruction is a congenital defect of the digestive tract that completely or partially blocks the duodenum (the first part of the small intestine). A diaphragm located at the D2 segment accounts for 85-90% of diaphragmatic obstructions.
The cause of this condition has been identified as follows: The primitive duodenum is a hollow tube from the 4th week of gestation. The intercellular plug develops strongly, causing the duodenal tube to solidify. By weeks 8-10, vacuolation occurs, and the intercellular mass forms hollow spaces. These spaces then connect to each other, restoring patency of the duodenum. Any defects in this "perforation" process that halt the process will cause the formation of a duodenal diaphragm.
Vomiting and abdominal distension are early signs and reasons why parents should take their children to the doctor. If this condition persists, it can lead to electrolyte imbalance and malnutrition.
This is a relatively rare condition, affecting 1 in 6000 newborns. Boys are more likely to be affected than girls, and it is often associated with other birth defects such as heart defects, Down syndrome, and other gastrointestinal abnormalities.
Dr. Nguyen Van TuanWith extensive experience in pediatric surgery, and having directly performed surgery on baby P, he stated: "Complete duodenal obstruction is a surgical emergency in newborns. If not detected and treated promptly, the child may experience gastrointestinal obstruction, vomiting leading to fluid loss, weight loss, electrolyte imbalance, shock, seizures, and potentially death."
In cases of incomplete duodenal obstruction in the neonatal and pre-weaning stages, infants may experience more frequent vomiting than normal. However, from the time of weaning onwards, the frequency and amount of post-feeding vomiting increase, with significant abdominal distension in the epigastric region. At this point, the child experiences stunted growth, malnutrition, and weakness.
Mothers should undergo a comprehensive ultrasound in the last three months of pregnancy to screen for and intervene early in the baby immediately after birth.
