From discovering an abdominal cyst in the fetal period, to undergoing surgery 2 days after birth, to recovering and being discharged from the hospital at the age of one and a half months, little girl Yueyue's initial stage of life seemed a bit bumpy.

From the discovery of abdominal cyst in the fetal period, to the surgery 2 days after birth, to recovery and discharge from the hospital at the age of one and a half months, little girl Yueyue's initial stage of life seemed a bit bumpy.

From the fetal stage, The First Affiliated Hospital of Sun Yat-sen University Department of Obstetrics, Dermatology, Medical Imaging, Department of Ultrasound, Department of Pediatric Surgery, Neonatology, Children's Intensive Care Unit and Department of Anesthesiology and operating room teams treat little ones Through caring and caring, the serious skin disease of Yueyue’s mother, Ms. Meng Lin, was solved in time; the nature of Yueyue’s abdominal cyst was determined early; and then two days after her birth, she decisively performed surgery to remove the cyst, correct the intestinal volvulus, and establish Unblock the intestines to avoid the risk of ischemic necrosis of the small intestine, the child's nutrient absorption organ, and the risk of short bowel syndrome ; then, the little guy overcame various postoperative difficulties one by one, just like fighting monsters and upgrading. When he was discharged from the hospital, it was evaluated that his enteral feeding was normal and his growth and development were good. He would be able to thrive like other children in his future life.

When a congenital disease is discovered

The expectant mother has to overcome all difficulties to give birth to her.

Yueyue's mother Meng Lin is a multiparous woman who has given birth to one child. After the first childbirth, before Yueyue was born, she had a pregnancy. But unfortunately the baby passed away when she was more than 2 months pregnant.

After Yueyue became pregnant, Meng Lin's family was both happy and anxious. The joy is that another little life has been conceived, but the uneasiness is the fear that the misfortune of the second child will happen again. After confirming her pregnancy, the expectant mother's prenatal checkup was very positive. It is precisely because of the current progress in maternal-fetal medicine and the development of advanced imaging equipment that when Meng Lin was 24 weeks pregnant, prenatal ultrasound and MRI discovered a 5cm-sized cyst in the belly of the little one during the fetal stage. At that time, the imaging examinations in various prenatal hospitals considered the cyst to be a benign mesenteric cyst. When reexamined at 27 weeks of pregnancy, the imaging diagnosis still showed a fetal abdominal cyst, and intestinal duplication malformation was not ruled out.

To be on the safe side, Meng Lin underwent amniocentesis fetal chromosome examination and gene chip monitoring. The final conclusion showed that no genetic problems were found. This undoubtedly strengthened the determination of the expectant mother and her family to give birth to her.

Congenital problems were discovered during the fetal stage. The baby was already destined to have a difficult life, and as a mother, Meng Lin's pregnancy was also full of ups and downs. She has been suffering from dermatitis since she was 2 months pregnant. Her whole body was covered in rashes, which were unbearably itchy. Many of the rashes even caused ulcers, scabs, and cracks, causing pain. She went to many specialists and doctors. After being admitted to a comprehensive medical institution, her status as a pregnant woman and her complicated condition caused many dermatologists to be wary and cautious during treatment, so the treatment effect was not obvious.

After suffering from dermatitis and itching for several weeks, Ms. Meng found Professor Wang Zilian, deputy director of the First Affiliated Hospital of Sun Yat-sen University and a famous obstetrician, for help. After the obstetrician's preliminary judgment and referral to the dermatology department, Professor Han Jiande from the dermatology department of Zhongshan First Hospital began to take over the diagnosis and treatment of pregnant women. After the obstetrics and dermatology departments made it clear that dermatitis during pregnancy would not harm the fetus, they used a variety of strategies to control the pregnant woman's skin symptoms. Meng Lin was discharged from the hospital after her rash and itching were significantly relieved.

Continue to follow up and track

This cyst in the fetus has been highly concerned.

solved the problem of rash in pregnant women, and the growth and development of the fetus in the abdomen still needs close attention. Meng Lin was quickly referred to Professor Luo Yanmin, director of the obstetrics department of the hospital. Professor Luo Yanmin developed a detailed multidisciplinary collaborative diagnosis and treatment plan for her: regular obstetric examinations during pregnancy to ensure the safety of the mother, ultrasound dynamic monitoring of fetal growth and development and changes in abdominal cysts; peripartum obstetrics, neonatology, pediatric surgery, pediatric intensive care unit (PICU) ) and the anesthesiology department jointly discuss the timing, method of delivery, and neonatal treatment plan. After Meng Lin understood the treatment plan, her anxiety immediately eased and she became more confident in continuing her pregnancy.

In order to find out what the 5-centimeter cyst on the little guy was, Professor Xie Hongning from the Department of Ultrasound Medicine conducted a detailed ultrasound examination for Meng Lin.Professor Xie Hongning told Nandu reporters that no matter how advanced the current imaging methods are, it is impossible to make a diagnosis of pathology under the triple barrier of maternal body, amniotic fluid , and fetal body. Pregnant women had previously undergone ultrasound and MRI examinations in many hospitals. The imaging examinations gave clues to as many as six or seven diseases, including intestinal malformations, mesenteric cysts, lymphoceles, and ovarian cysts. "Such fetal tumors may originate from various tissues. Before clear pathological examination , there are unlimited possibilities for diagnosis."

Based on many years of clinical experience, Professor Xie Hongning proposed that the child suffers from intestinal duplication malformation. (During fetal development, a structure similar to an intestinal tube grows on one side of the small intestine).

"But no matter what kind of disease or diagnosis, the risk of children developing volvulus and intestinal atresia after birth is very high, and they need to be paid close attention to." Professor Xie Hongning told Nandu reporter.

Meng Lin persisted until she was 35+4 weeks pregnant. Professor Xie Hongning conducted an ultrasound consultation and found that the intra-abdominal cysts in the fetus had increased compared with before, and there were polyhydramnios and a little pericardial effusion .

Professor Luo Yanmin immediately organized Professor Fan Miao from the Department of Medical Imaging, Professor Xie Hongning from the Department of Ultrasound Medicine, Professor Liu Juncheng from the Department of Pediatric Surgery, Professor Tang Wen from the PICU, Professor Huang Yuefang from the Neonatology Department and obstetric colleagues to conduct a multidisciplinary consultation to discuss the nature of the cyst and perinatal period precautions. The professors participating in the consultation conducted a detailed analysis of the pregnant woman's past medical records and information, and recommended that the patient and her family members closely observe changes in the fetal condition. If the condition does not progress, they can expect to have a full-term delivery.

Just when Meng Lin and the obstetric doctors and nurses were preparing to wait quietly for the baby to be delivered at full term, Professor Xie Hongning performed another ultrasound examination the day after the conference and discovered a new situation, that is, on top of the original cyst, there were also Dilatation of the small intestine and abnormal mesenteric blood vessels were observed. After careful analysis, the examination showed that this change may be secondary to intestinal volvulus on the basis of fetal intestinal duplication malformation, resulting in dilation of the intestinal tube in the upper part of the volvulus. Professor Luo Yanmin decided to admit the patient to the hospital immediately. At the same time, he organized another consultation with the Department of Ultrasound Medicine, Pediatric Surgery, Neonatology Department, PICU, Anesthesiology Department, and Operating Room in the afternoon of the same day. He formulated a detailed neonatal rescue plan and prepared for immediate surgery after birth. .

Everything was arranged well. The little girl Yueyue was successfully delivered and came into the world early the next morning after being admitted to the hospital. The child's birth score was normal. After the midwife took care of the little guy, Associate Professor Zhou Luyao and his team from the Department of Ultrasound Medicine, who were waiting next to the operating table, immediately conducted an ultrasound examination of the baby's abdomen and determined that it was "jejunal atresia."

Taking into account that the child's general condition is acceptable, the experts have fully evaluated and decided that emergency surgery is not needed for the time being, and the child can be transferred to the neonatology department for close observation.

Timely identification of abnormal signs

Teamwork Emergency start of surgical treatment

Yueyue was quickly transferred to the neonatology department for close monitoring. Professors Li Xiaoyu, director of the neonatology department, and Huang Yuefang, deputy director, both participated in previous consultations and were aware of the child's possible conditions. Progress has been made. Dr. Xu Lingling, the attending physician in charge, is paying close attention to the child's changes and progress.

The first day after the baby was born was relatively stable. On the second day, the little one had slight abdominal distension, but there were no other abnormalities. On Sunday, May 29, Dr. Xu Lingling keenly discovered that the baby had a low-grade fever and immediately reviewed the blood routine and related examinations, the results showed that inflammatory indicators were elevated. Dr. Xu Lingling immediately reported to her superior, Professor Huang Yuefang, and immediately strengthened antibiotic and anti-infection treatment under the guidance of superior experts. Almost at the same time, relevant information was immediately transferred to Professor Liu Juncheng of Pediatric Surgery.

"This is a signal that children have intestinal volvulus. If surgery is not performed in time, intestinal ischemia and hypoxia will last for a long time, which can lead to intestinal necrosis and perforation, which is life-threatening." Although it is Sunday, Professor Liu Juncheng has no doubts. He hesitated and immediately rushed back to the hospital for emergency surgery.

After emergency coordination by Professor Feng Xia from the Department of Anesthesiology and Gong Fengqiu, the head nurse in the operating room, the child's preoperative anesthesia work was carried out in an orderly manner.Different from adult surgery, Yueyue was only a two-day-old baby at this time. It is also very important to keep the operating table warm for this type of baby to ensure that the child's body temperature is stable during the operation.

After the maternal cesarean section , the ultrasonic doctor immediately performed a B-ultrasound examination on the newborn in the operating room

On the approaching June day in Lingnan, in front of the operating table with the heating system turned on, Professor Liu Juncheng's team was sweating profusely, Xiuzhen's version of intestinal surgery was methodically performed on the little guy who weighed just over 3 kilograms. They carefully and carefully removed the cyst located in the jejunum of the child's and reconstructed the child's small intestine. In order to ensure the length of the child's small intestine as much as possible, every step was carried out meticulously. Where to cut and where to keep, surgical experts make careful progress while weighing every detail. "The neonatology department's early symptom judgment is very accurate. When the abdomen is opened during surgery, the child actually has volvulus, so timely identification and timely surgery are crucial." Professor Liu Juncheng said.

After more than two hours of delicate operation, the surgical team walked off the operating table soaked in water. Only about 4 centimeters of the little guy's small intestine was amputated, and the remaining small intestine was enough to avoid the possibility of short bowel syndrome and ensure the child's future nutrient absorption, growth and development. Professor Liu Juncheng told Nandu reporters that the postoperative pathological results of the removed cysts showed benign intestinal duplication malformation. "I have to admire our prenatal ultrasound team. They made an accurate prediction despite the three-layer barrier of mother's body, amniotic fluid and fetus."

carefully cared for and treated the child for more than a month

recovered and was discharged from the hospital

He was transferred to the Pediatric Intensive Care Unit (PICU) with a ventilator and intubation, and Professor Tang Wen's team began to take over the follow-up monitoring of the child. "When the child was transferred, he was still wearing a ventilator and intubation, his body temperature was slightly lower than normal, and he also had abnormal inflammation and coagulation indicators and biochemical disorders. However, after seven days of treatment and correction one by one, the child's condition was stabilized. and control.”

Li Zhiying, head nurse of gynecology and pediatrics, told Nandu reporters that feeding newborns who have undergone gastrointestinal surgery is a very delicate task. Enteral feeding was not possible in the first week after surgery, and the central venous catheter placed before the operation was relied upon to maintain nutritional infusion. Children need intravenous nutrition support for a long period of time after surgery, because it takes a long time to establish enteral feeding after surgery and requires careful observation and continuous evaluation. "Infection prevention and control is also very important for children receiving intravenous nutrition for a long time. Our medical staff took good care of the child, and no infection occurred during the hospitalization. This delicate little guy had feeding intolerance at the beginning. When the mother had no breast milk, we promptly adjusted the feeding of deeply hydrolyzed formula milk powder, and the child slowly began to tolerate the feeding, and his weight gradually caught up. "

At present, the child has resumed oral feeding and drinks a lot of milk every day. . In this way, from the uterus to the outside of the uterus, from the fetus to the newborn, after overcoming difficulties one after another, the child finally returned to normal, grew and developed well, and the parents took the child home from the hospital with gratitude, gratitude and happiness.

"Despite suffering for more than two months, mother and daughter are finally safe. This is inseparable from the superb medical skills and medical skills of the professors and medical teams in the Department of Obstetrics, Ultrasound Medicine, Dermatology, Pediatric Surgery, PICU, and Neonatology Department of Zhongshan First Hospital. Take good care of her." On the eve of her child's discharge, her mother Meng Lin wrote a heartfelt letter of thanks. She said sincerely: "We are really lucky to have met the expert team of Zhongshan No. 1 Hospital in helplessness and confusion. We feel extremely strong support, and even the most fragile hearts have the courage to overcome all difficulties, igniting the undying confidence to wait for the light.”

(Due to the privacy of pregnant women and children, Meng Lin and Yueyue are pseudonyms in the article. )

Written by: Nandu reporter Wang Daobin, intern Shen Ruibing

Correspondent Peng Fuxiang and Liang Jiayun