CASES OF THE WEEK - “Neonate with Eventration of the left diaphragm and stomach perforation” by Dr Wissam AlTamr, Specialist Paediatric Surgery & Dr Jayasheela Kannan, Specialist & HOD, Neonatology, NMC Royal Hospital Sharjah

Neonate with Eventration of the left diaphragm and stomach perforation

A baby boy, 35 week gestation was born with respiratory distress admitted under Dr Emad El Shafie, Specialist Paediatrician. The baby at 36 hours of age was transferred under the care of Dr Jayasheela Kannan, Specialist Neonatology in view of need of ventilator support. As X-ray showed eventration of diaphragm with evidence of gut perforation, baby was intubated.

Dr Wissam AlTamr, Specialist Paediatric Surgery after examining the baby  immediately planned for urgent exploratory laparotomy at 3AM. It was a high risk surgery and required an anaesthetic expertise with experience in neonatal emergencies. Dr Ayman Hassan, Consultant Anaesthesiology and OT team were very professional  in their assistance in the surgery.

The baby was shifted to the operation theater and emergency exploratory laparotomy was performed under general anesthesia. The patient’s stomach was perforated with acidic contents filling the abdomen. The stomach and spleen were found migrating to the left chest, pushing the left lung and causing complete collapse of the left lung.

The stomach perforation was repaired and the diaphragm eventration was repaired. We did plication to left diaphragm which allowed the left lung to expand like a normal lung. The surgery lasted for three hours and the baby was shifted to NICU for post operative management.

Under Dr. Jayasheela Kannan, PIC line was inserted and TPN started. Cardiac echo showed mesocardia. The baby was extubated and the feeds started gradually which the baby tolerated. Dr. Jayasheela Kannan, Paediatric RMOs and nurses did a great job and the baby was discharged home in a perfect condition.

Such cases are highly risky and mortality is very high if not diagnosed and managed in early stage. This is the first case of extreme neonatal surgical emergency in our hospital. We thank Dr. Milind Raje, Consultant Radiology and Dr. Ahmed Kamali, Consultant Paediatric Cardiology for their valuable support in successfully managing the case.