TP HCMThe baby boy was born with a congenital tumor in the neck area, accounting for 1/3 of his body. In 4 months, the doctors performed three anal surgeries to resolve intestinal obstruction and remove the tumor.
The baby’s mother, 32 years old, was 31 weeks pregnant when a doctor at Tam Anh General Hospital, Ho Chi Minh City, discovered that the fetus had a goiter in the neck. At that time, a fetal ultrasound and MRI scan recorded a tumor measuring 6×6 cm, with the risk of compressing the mediastinum (thoracic cavity). 6 weeks later, a doctor from the Department of Obstetrics – Neonatology – Pediatric Surgery consulted to evaluate the large tumor, the possibility of the baby having postpartum respiratory failure, and indicated a cesarean section.
Doctor II Pham Le My Hanh, Head of the Department of Neonatology, said the baby was born at the end of 2023, weighing 3.4 kg, with a tumor size of 10×20 cm (weighing 1 kg) equivalent to a newborn’s head, pulling the neck through a curve. beside.
Many children are born with giant tumors in the neck and chest area, causing severe respiratory failure. “However, large tumors with intestinal obstruction like this baby are very rare. This is the first case I have encountered in many years of practice,” said Dr. Nguyen Do Trong, specialist in Pediatric Surgery.
After birth, the baby had a bloated stomach, spit up green fluid, did not eat milk, and did not have bowel movements due to intestinal obstruction. The doctor had to perform emergency surgery to relieve the baby’s digestive tract circulation.
Congenital intestinal obstruction is caused by meconium plugs blocking the intestinal lumen. Secretions in the digestive tract are mucous and stick to the intestinal mucosa, causing feces to stagnate in the colon and prevent bowel movements. Intestinal obstruction due to meconium accounts for about 33% of small bowel obstruction cases in newborns.
The baby had a temporary ostomy on the abdomen, and the intestinal tract containing meconium underneath was irrigated. After 2-3 months of waiting for the lower intestine to have enough time to expand and for the biopsy results of the lower intestine of the temporary anus to be normal, the doctor sutures the intestines and closes the temporary anus. At that time, the baby can go to the toilet.
Dr. Trong assessed the tumor as dangerous but did not compress the airway. The baby is only 4 days old and cannot undergo many surgeries, so he should be monitored further.
After surgery to treat intestinal obstruction, the baby was fed intravenously with adequate nutrition and recovered quickly. However, the lymphoma progressed unfavorably, showing signs of infection. The tumor invaded the muscles of the chest and neck on the left side, surrounding the vascular and nerve bundles. At this time, if surgery is not performed, the tumor will be too large and the baby will have a crooked head and neck, dislocated shoulders, and will compress the airway, causing respiratory failure and skin necrosis.
The baby boy was cared for at the Neonatal Center and gained weight well in preparation for surgery. Image: Tue Diem
This case is difficult to remove the tumor because of the risk of damaging blood vessels and nerves, leaving many sequelae for the baby such as arm paralysis, affecting motor function in the neck,” Dr. Trong said, adding that a team is needed. Good anesthesia and resuscitation are on duty in the operating room. The process of creating the cover and handling the skin flap also needs to be aesthetically pleasing, to avoid scarring, so that the baby grows up feeling less self-conscious and self-conscious.
In mid-January, the team removed the tumor and the risks of vascular and nerve damage were controlled. After surgery, the baby ate and slept well, easily tilted and turned his head and turned over on his own when he was three months old.
Doctor II Nguyen Do Trong (middle) performs surgery to close the anus. Image: Tue Diem
At the end of April, the doctor performed the third surgery including connecting the intestines and closing the temporary anus on the baby’s abdomen. Babies can go to the toilet like normal people.
Lymphomas often form in the fetal stage or in children born under 5 years old. The cause of the disease has not yet been clearly determined. There are some studies that suggest that lymphoma is formed in the fetus due to improper development of the lymphatic system, related to genetic mutations. There is currently no way to prevent the disease.
After 120 days of birth, the baby went to the toilet on his own and no longer had a giant tumor. Image: Tue Diem
The Ministry of Health records that about one million children are born each year, of which 22,000-30,000 have birth defects. By 2023, Vietnam will have about 1.2 million disabled children aged 0-17, a rate of 3.1%. According to Dr. Trong, lymphoma and congenital intestinal obstruction are two defects that can be corrected and intervened after birth. With early intervention, many children recover well and live normal lives.