CASE OF THE WEEK – "Rare case of preterm female 1.1 kg with midgut malrotation and volvulus" by Dr. Wissam Altamr, Specialist, Paediatric Surgery & Dr. Jayasheela Kannan, Specialist, Neonatology at NMC Royal Hospital Sharjah

CASE OF THE WEEK – "Rare case of preterm female 1.1 kg with midgut malrotation and volvulus" by Dr. Wissam Altamr, Specialist, Paediatric Surgery & Dr. Jayasheela Kannan, Specialist, Neonatology at NMC Royal Hospital Sharjah

Preterm (28 +3 week gestation) female baby with birth weight of 1.165 kg was born by emergency LSCS. The baby had bradycardia and had to be intubated in OT. Baby admitted under the care of Dr. Jayasheela Kannan, Specialist Neonatologist and NICU team.

In NICU, baby connected to mechanical ventilator. Survanta was given, Septic work up done and started IV fluids, IV antibiotics, Fluconazole prophylaxis and caffeine. Umbilical venous line was inserted ,TPN was started. The Cardiac echo conducted by Dr. Fadil Husrom, Consultant Paediatrics & Specialist, Paediatric Cardiology showed large PDA3.2mm with Lt to Rt shunt. Medical closure was done with paracetamol followed by Ibuprofen. OG feeds gradually started and increased. Later Baby was extubated and kept on SIPAP. The UVC was removed in the 2nd week after baby started tolerating feeds.

On Day 22 of life baby had significant abdominal distension with features of obstruction. Baby was intubated and ventilatory support given. Paediatric Surgery consultation with Dr Wissam Altamr, Specialist, Paediatric Surgeon was obtained.

Patient had surgical abdomen and needed Emergency laparotomy. With support from Dr Mohamed Ghanima, Specialist Anaesthesiologist and OT team, the surgery was done by Dr Wissam and found midgut malrotation with volvulus and necrotic of the first part of the ileum and end part of jejunum wall with length less than 40 cm without clear perforation.

Reduction of the volvulus, lad procedure and resection of the 40 cm from the small bowel with primary anastomosis was done. Patient tolerated the procedure well and shifted to NICU for post operative care. PIC line was inserted and TPN was restarted. Baby was extubated day 3 post surgery. Gradually feeding restarted on Day 5 post surgery and baby tolerated full feeds.

Histopathology result : ILEUM, RESECTION - Volvulus with transmural infarction consistent with gangrene. The resection ends are viable. The mesenteric veins show thrombosis.

After 55 days of hospital stay baby discharged with weight of 2 kg at corrected gestation of 36+1 weeks on bottle feeds and breast feeds in good condition.

Big thanks for all the team at NMC Royal Hospital, Sharjah who helped us to manage this case:

  • Dr Mohamed Abo Ghanima, Specialist Anaesthesiologist
  • Dr. Pooja Agrawal, Specialist Neonatologist
  • Dr. Ehsan Ahmad, Specialist Histopathologist
  • Paediatric RMO & Surgical RMO team
  • NICU team, Radiology and OT team
BEFORE SURGERY
DURING SURGERY
AFTER RESECTION AND ANASTOMOSIS
TEAM AT NMC ROYAL HOSPITAL, SHARJAH