Moolchand Hospital : 48-hr old baby undergoes laparotomy in rare case of gut cyst

A 48-hour baby suffering from a rare case of gut cyst and volvulus successfully underwent laparotomy at Moolchand hospital. The 38-year-old mother of the child presented with premature labour in emergency last week. The mother was suffering from multiple medical problems and had earlier undergone fertility treatment. The mother had to undergo a caesarean section at 34 weeks gestation. S Senior Consultant Obstetrics and Gynaecology, Moolchand Hospital said, “During antenatal ultrasound intra-abdominal cyst in fetus was seen and parents were informed about it”.

Laparotomy is a surgical incision into the abdominal cavity, for diagnosis or in preparation for major surgery.

The procedure was a delicate one as the premature child of 2.6 kg had a swollen abdomen and was throwing up green vomit.

“It’s a rare, challenging case of a pre-term, 2.6 kg body weight baby with bilious vomiting and abdominal distension at birth.” She got the USG abdomen of the baby done which showed small bowel obstruction and intra-abdominal cyst,” said Dr.Preeti (consultant paediatrics).

The biggest challenge in these surgeries is to sedate the pre-term baby. Manish Jagia (Director Anesthesia & Critical care) highlighted, “It is a challenge to anaesthetize a preterm, low birth weight baby but with all precautions and facilities available at Moolchand, the baby was prepared for the surgery”.

Dr.Anand Sinha (Consultant ,pediatric surgery) added “such cases should be done as early as possible to prevent sepsis in newborn”. He observed prenatal ultrasound only showed cyst but intra-operatively there was volvulus with band in addition to meconium peritonitis with a lot of adhesions. During surgery a part of the intestine of the newborn had to be resected and rejoined.

The possibility of meconium peritonitis with volvulus is one in 30,000. It is a rare presentation with few reports available on it.

Meconium peritonitis is defined as aseptic chemical inflammation caused by intrauterine bowel perforation. The underlying causes of bowel perforation include intestinal atresia, midgut volvulus, intussusception, congenital bands, and meconium ileus.

Baby was kept on a ventilator overnight and extubated the next day. Baby is recovering now in the NICU and will be discharged shortly.