The first in UAE and the third published medical case globally
The case was diagnosed at 34 weeks of gestation in Danat Al Emarat’s Fetal Medicine Unit
Surgeons in Abu Dhabi successfully treated an Emirati newborn baby suffering from a rare congenital malformation of the intestine, which led to perforation of the small bowel, filling his whole abdomen with fluid which required immediate intervention to save his life.
The case was diagnosed at the Fetal Medicine Unit of Danat Al Emarat Hospital, part of United Eastern Medical Services, during the 34th week of gestation, and the baby was delivered few days later due to progressive worsening in the unborn baby’s condition. After birth, immediate medical attention to support breathing was required, followed by a thorough surgical evaluation due to increased abdominal distention and clinical deterioration for which a 4-hour urgent surgery was performed to save the baby’s life.
According to international published medical and scientific journals, the newborn’s rare case is considered the first in the UAE and the third published case worldwide.
Mohammed Ali Al Shorafa Al Hammadi, CEO of United Eastern Medical Services, “The capabilities of our medical multi-disciplinary team at Danat Al Emarat Hospital are evident in managing rare and complex cases. The newborn was treated in a timely manner in the hospital’s level III Neonatal Intensive Care Unit and Pediatric Surgery department led by a team of internationally-trained physicians.”
“The development of a comprehensive scope of medical services including fetal medicine, pediatrics and neonatology, pediatric surgery along with an advanced neonatal intensive care unit led by an experienced medical team are all essential in caring for high risk pregnancies, rare cases, sick newborns and premature babies,” he added.
Dr. Raja Cingapagu, Pediatric Surgeon at Danat Al Emarat Hospital, who performed the baby’s successful surgery along with a surgical team of various specialties said, “upon the diagnosis of the fetus’ condition during the 34th week of pregnancy, a multi-disciplinary team was formed, including a pediatric surgeon, neonatologists, pediatric anesthesiologists, obstetricians and fetal medicine specialists, laboratory services as well as physicians from other supportive specialties to review the case and put a treatment plan. A decision was then made by the obstetricians to deliver the baby within a few days.”
“A number of tests were done to the newborn to identify the reason for the increased accumulation of fluid in the abdomen and huge abdominal distention. However, various scans did not show the exact problem of the intestine as the abdominal was covered with fluid. An emergency surgery was decided, which lasted for 4 hours during which the birth defect was identified as an intestinal tubular duplication cyst of 15-cm-long of the small bowel, which led to twisted bowel and perforation during late gestational period leading to fluid accumulation in the abdominal cavity,” he added.
He also explained that during the surgery, the defective bowel, which was 15-cm-long, was resected. The healthy bowels were reconnected to each other and the abdominal cavity was cleared. He noted that a newborn’s small intestines are 100-cm-long, and that resecting 15 cm of it pose no risk to the baby, as babies’ bowels grow until they are 600-cm-long in adulthood. However, the baby needs regular check-up for nutritional assessment and supplementation if required.
Dr. Raja said that the surgery was considered complex for a number of reasons, including the fact that the case was extremely rare, the baby was premature and there was so much fluid in his abdominal cavity, which made addressing the cause of the problem very difficult.
“This case is complex, rare, the first of its kind in the UAE and the third of its kind in the world according to medical references, whereas the first case took place in 1979, and the second in 2005 in France,” Dr. Raja further affirmed. “After surgery, the baby was nursed in NICU by the team of neonatologists led by Dr. Iviano Ossuetta, for 2 weeks and recovered well, without any complication.”
He explained that a delay in medical intervention in such cases would lead to serious complications like gangrene in the bowels and internal organs leading to death, and in case the bowels were not perforated, it may turn at some stage into a malignant tumor.
Highlighting the role of Fetal Medicine in the timely diagnosis of similar cases, Dr. Gowri, Head of Obstetrics & Gynecology and Director of Fetal Medicine Unit at Danat Al Emarat Hospital, said that the mother had visited the hospital to follow up on her pregnancy. As part of our protocol of caring for pregnant women, specific visits are performed within the Fetal Medicine Unit. The baby’s mother was in her 34th week of pregnancy and the scan showed that the baby’s abdomen was massively distended by fluid, a condition called fetal ascites. The decision for delivery was made once it was noticed that the condition was worsening very rapidly, to address the problem and save the baby’s life.
The baby’s father, Mr. Al Mansouri, expressed how delighted he was with the success of his son’s surgery and that his son’s life was saved, noting that when the physicians at Danat Al Emarat Hospital notified him of his son’s health issue and that a surgery was necessary for saving the newborns’ life, he immediately gave his consent.
“When the physicians decided to perform an urgent surgery for my son, I did not hesitate to have it performed at Danat Al Emarat Hospital. The medical team was able to diagnose my son’s case before birth and they are known for their competency. I did not consider having it performed abroad because it was a rare urgent case.” He also highlighted how early diagnosis of the case helped in developing a successful treatment plan and saving the baby’s life from serious complications which could have occurred if the treatment was delayed.
“This is our family’s second baby, and, thanks to Allah, he is now in good health.” Al Mansouri said. He further thanked the hospital’s management and the medical team for taking good care of his wife during her pregnancy and the evident care provided to his newborn baby.