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 a large dilated stomach containing a lot of food and being folded.

After being examined by a pediatric surgeon, combined with a standing X-ray of the stomach and duodenum showing a double bubble image, a contrast X-ray of the stomach and intestines showed that the stomach was dilated to the D2 segment of the 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 the results of clinical and paraclinical examination, 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 septum 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 took place within 60 minutes, the 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 malformations.

The cause of this disease 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, by the 8th - 10th week the process of vacuolization occurs, the intercellular plug forms hollow cavities, these hollow cavities then connect together to make the duodenum open again. Any defect in the process of "opening up" will cause the duodenal septum.

Vomiting and abdominal distension 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 malformations such as: Heart defects, Down syndrome and other gastrointestinal malformations.

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, loss of fluid, weight loss, electrolyte disturbances, 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 comes, the occurrence of vomiting after eating increases in frequency 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."