Just 18 hours old and weighing only 1.8 kg, a newborn baby was brought to Sarvodaya Hospital, Sec 8, Faridabad, in a critical condition, with his intestines sticking outside his abdomen (located between chest and pelvis).
According to the referring paediatrician, the baby had required CPR immediately after birth after developing signs of severe infection (sepsis). He remained under their care for nearly 8 hours before being referred to Sarvodaya Hospital for specialised neonatal and surgical management.
Despite multiple antenatal scans, no abdominal wall issue had been documented before birth.
On arrival, the baby was critically ill and required immediate stabilisation, detailed evaluation and urgent multidisciplinary assessment. Considering his very young age, low birth weight, severe infection and exposed intestines, the medical team acted swiftly to determine the safest course of treatment.
Overnight, the baby underwent the necessary blood investigations, imaging and diagnostic evaluation. The investigations revealed a rare and severe congenital condition:
Ruptured Omphalocele with Intestinal Prolapse through a Persistent Patent Vitellointestinal Duct Remnant : A rare birth defect in which the baby’s abdominal wall opening had been torn, causing the intestines to come outside the abdomen through an abnormal connection that should have been disappeared before birth but remained.
As babies with omphalocele can also have associated congenital heart defects, a detailed cardiac evaluation through Echo was performed. The assessment revealed a Ventricular Septal Defect (VSD), a hole between the heart’s two lower chambers.
This added another layer of complexity to an already critical surgical condition.
Given the baby's extremely fragile condition and the complexity of the case, an emergency multidisciplinary conference was conducted. The team included specialists from Paediatric Surgery, Paediatric Cardiology, Neonatal Critical Care, Radiology, Anaesthesiology and other supporting departments.
In the early hours of the morning, the baby underwent emergency surgery, headed by Dr Shweta K. Sharma, Senior Consultant, Paediatric Surgery, to address the abdominal defect and protect the exposed intestines. At the same time, the medical team continued aggressive management of the baby's sepsis and critical condition.
Following surgery, the newborn was shifted to the Neonatal Intensive Care Unit (NICU) for close monitoring and specialised postoperative care.
Ruptured Omphalocele with Intestinal Prolapse through a Persistent Patent Vitellointestinal Duct remnant.
Ruptured: means torn, broken open, or no longer intact.
Omphalocele: In an omphalocele, some abdominal organs do not return completely inside the abdomen. Instead, they remain outside and protrude through an opening around the belly button (umbilicus) in a sac.
During normal development inside the womb, a baby's intestines temporarily move outside the abdominal cavity because the baby's abdomen is still developing. They usually return inside the abdomen before birth. But in case of Omphalocele, they remain outside in a sac.
In this case the baby is born with an opening near the belly button, through which his intestines are outside the abdomen but covered by a protective sac.
During delivery, the sac containing the intestines was ruptured that made the condition more critical.
Intestinal Prolapse: a portion of the baby's intestine has come outside the abdominal cavity through an abnormal opening.
Persistent Patent: Persistent means something that remains when it normally should have disappeared or closed and patent means open.
Vitellointestinal Duct: Vitelline refers to the yolk sac, an important temporary structure involved in early development of the embryo.
Intestinal refers to the intestine.
Duct is a tube like structure
So, the Vitellointestinal Duct is a temporary tube-like connection between the developing intestine and the yolk sac during early pregnancy.
This connection is useful during early fetal development, but it is normally supposed to disappear as the baby develops.
Remnant: something leftover
The exact diagnosis: The baby had a rare birth defect in which an opening near the belly button allowed the intestines to come outside the abdomen. The protective covering had broken, and the intestines had further come outside through an abnormal fetal connection that should normally have closed before birth.
VSD: The baby also had a small hole in his heart (between two lower chambers).
The baby reached Sarvodaya Hospital at around 8 PM. An emergency multidisciplinary assessment was initiated immediately.
The paediatric team began medical stabilisation while the cardiac team was called in for an urgent evaluation. Despite the unusual hour, a screening echocardiogram was arranged during the night, with the cardiac assessment done by Dr. Jay Relan, Senior Consultant - Paediatric Cardiology & Congenital Heart Disease.
The echocardiogram revealed a congenital heart defect.
Fortunately, the cardiac abnormality was not severe and was expected to improve on its own. There was also no contraindication to proceeding with anaesthesia.
With the cardiac concern addressed, the focus shifted to the baby's abdominal condition.
After extensive counselling and assessment, the decision was made to proceed with emergency surgery early the next morning.
The baby was taken up for surgery at 7 AM the next morning—just 18 hours after birth.
At only 1.8 kg, the newborn was extremely fragile.
Emergency surgery in such a low-birth-weight baby carries significant risks. The team had to carefully assess the condition of the intestine and determine whether it was adequately developed and viable.
One of the major concerns was intestinal atresia or inadequate bowel development, which could potentially leave the baby with insufficient intestine and result in short bowel syndrome.
The family was counselled extensively about the possible findings, the surgical risks and the uncertainty surrounding the condition of the intestine.
With one surgery, the surgical team encountered the complex congenital anatomy that had been anticipated.
The remarkable part of this case was that all three associated abdominal defects could be addressed during the same surgery and at the same stage.
Instead of requiring separate staged procedures, the surgical team was able to perform a definitive repair in a single operative setting.
The intestine was carefully assessed, managed and returned to the abdominal cavity, while the congenital defects were repaired.
The abdominal wall was reconstructed with careful attention.
Despite the complexity of the condition, the repair was cosmetically excellent, with minimal visible scarring.
For an 18-hour-old baby weighing just 1.8 kg, this was a remarkable surgical achievement.
The baby was shifted to the NICU for intensive postoperative care and monitoring.
Given the baby's critical condition at birth and the complexity of the surgery, there was a significant risk of postoperative complications, particularly infection and sepsis.
The medical team closely monitored the baby's breathing, circulation, bowel function, infection markers and ability to tolerate feeds.
After 48 hours, the baby could be successfully extubated.
The baby's infection subsequently settled, and the clinical condition gradually improved.
The newborn remained under close observation in the NICU while feeds were carefully introduced and advanced according to tolerance.
The tiny baby who had arrived in a critical condition was now taking feeds and showing encouraging signs of hope and recovery.
The surgical wound healed well and the baby continued to remain under observation till he was completely recovered and discharged to go home.
Omphalocele is often identifiable during antenatal ultrasound scans during pregnancy.
Detecting the condition before birth allows doctors to:
However, congenital abnormalities can occasionally remain undetected during pregnancy.
In this case, despite multiple antenatal scans, the condition had not been documented antenatally.
This meant the family and the medical team had to deal with a major congenital surgical emergency immediately after birth.
The successful management of such a fragile newborn requires much more than surgery alone. Sarvodaya Hospital brings highly skilled multidisciplinary team of doctors who offer round-the-clock care to patients of all ages.
This case wouldn’t have been possible without the team effort and support. It involved close coordination between:
Early consultation with a paediatric surgeon can play an important role in the timely diagnosis and management of surgical conditions in newborns and children.
A paediatric surgeon can assess the condition, many times during pregnancy only, determine whether surgery is required, identify potential complications, and guide parents and the medical team on the appropriate treatment plan. It keeps everyone ready and prepared for timely treatment post birth.
Early specialist involvement also allows timely coordination with other specialists, when required, and helps ensure that the child receives appropriate care without unnecessary delays.
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