Dr. Prashant Jain
Sr. Consultant
Paediatric Surgery
BLK Centre of Neonatal,
Paediatric and Adolescent
Medicine
BLK Super Speciality Hospital

“The main challenge was to stabilise the child and manage his 'Short Gut Syndrome' which could have led to extreme nutritional deprivation.”

THE CASE

Ankur, a 6 year-old boy was brought to BLK Emergency in a very critical condition and under tremendous shock. He was suffering with acute abdominal pain for the past 24 hours and had multiple episodes of vomiting.

THE PROCEDURE

Ankur was immediately resuscitated with ion tropic and ventilator support. Paediatric surgery team was called immediately to rule out any surgical cause of his rapidly deteriorating condition. The surgical team suspected of intestinal gangrene and advised for urgent surgery to remove the gangrenous portion. Surgical exploration was done and it was found that except for about 100 cm of proximal small intestine (jejunum) and colon, rest of the small intestine was completely black (gangrenous). CT scan of the abdomen showed a very rare finding of a major blockage of one of the veins supplying to the intestine which led to the gangrene. With the help of the Haematology team, complete work-up was done to ascertain the cause of the thrombus formation.

On post-op day 8, the child again developed severe abdominal pain with blood in the vomit and stools. Repeat CT scan of the abdomen was done which showed suspected new gangrenous changes in the remaining small intestine. A second surgery was conducted by the surgical team which involved removal of 5 cm long gut. Paediatric Gastroenterologist and Nutritionist were then involved to gradually establish his enteral feeds and digested formula feeds were given. This was one of the rarest case which involved close coordination of multiple departments – Paediatric Critical Care, Paediatric Surgery, Haematology, Paediatric Gastroenterology, Dietetics & Nutrition.

THE RESULT

Presently, after 6 months of his illness, Ankur is growing well and is gradually gaining weight. He is under follow-up care of Paediatric Gastroenterologist and Nutritionist for his nutritional assessment.