- Intestinal obstruction in a fetus is a rare condition and can be fatal if not treated by performing an emergency surgery
- A fetus of less than eight months successfully delivered through C-section and operated for mal-rotation of intestine with obstruction
Doctors at Columbia Asia Hospital, Pune successfully saved the life of baby who was identified with a complicated and life-threatening intestinal obstruction and mal-rotation with mid-gut volvulus, which is very rarely found in fetuses.
The mother Hiral (name changed) was referred to Columbia Asia Hospital –Pune, from a private hospital, after a routine ultrasound done at seven and a half months showed the fetus had a mal-rotation which would cause an intestinal obstruction.
The parents were counselled and advised to come to Columbia Asia Hospital Pune for delivery as the baby would require immediate attention and surgery to correct the condition, which if untreated could be fatal.
The multi-disciplinary team of consultants, including the Obstetrician, pediatrician, pediatric surgeon and neonatologist decided that the patient would be monitored closely and nearing the expected date of delivery would perform a caesarean section. The baby was delivered safely and handed over to the care of the pediatric team headed by Dr Pranav Jadhav, Pediatric Surgeon, Columbia Asia Hospital, Pune.
Intestinal obstruction due to mal-rotation of the intestine and midgut volvulus, though rare, can occur at any age. With greater risk in male than female, such cases occur in 1: 6000 babies. While the condition does not have any relation with the age of the mother and parity, it has significant risk of neonatal mortality. With modern day techniques like ultrasound, it is possible to detect the condition while the baby is in the womb. Once detected the mother should deliver in a hospital with full-fledged pediatric support in the form of NICU (Neonatal Intensive Care Unit), pediatricians and pediatric surgeon.
Post delivery, the pediatric surgeon took charge and ordered an immediate X-ray and USG – abdomen. The reports confirmed the twisting of the intestines, which would lead to obstruction once the baby was fed.
“Intestinal twist and obstruction is very rare and fatal if not treated immediately. Today, thanks to periodic ultrasound tests on the mother during her pregnancy, the condition is detected in the womb and surgery is done as soon as possible after assessing the condition of the baby. If not operated on time, the condition stops the blood supply to the intestine and causes perforation, infection, sepsis and eventually death of the baby. The surgery was high risk as the baby was just born.
To ensure early detection of such conditions, it is essential that pregnant women undergo regular antenatal check-up. Also, it is important for them to plan their deliveries at a hospital that is equipped with contemporary medical facilities for ICU and pediatric surgery interventions. Timely intervention is the key for survival of such babies and so selection of a hospital with such services is essential when planning where to go for a delivery,†said Dr Pranav Jadhav, Pediatric Surgeon, Columbia Asia Hospital, Pune.
In a complex surgery that took one and a half hours to complete, Dr. Pranav Jadhav was able to correct the intestinal twist. Post surgery, the color of the intestine returned to normal within a short period of time and the newborn was able to pass normal stools, indicating the success of the surgery and equally important post surgery care under the supervision of Dr. Tushar Parikh (Consultant Neonatalogist) and his team. The baby was discharged after 8 days and is doing very well without any health complications.
“The case was high risk and required immediate surgical intervention. Delivering the baby via C-section was a conscious decision as it was important to deliver the baby without delay and conduct further investigations for confirming the diagnosis and starting treatment. Immediately after the delivery we did an X-ray of the baby which confirmed the existence of intestinal obstruction. Despite the complication, we are happy that the outcome of surgery was successful and the baby is developing normally. She has grown 3 weeks now and is doing well without any complications,†added Dr Pranav.
