Born with intestines out

Jun 11, 2013

Twenty-eight-year-old Tina Babirye, a resident of Kibale district, carried her second pregnancy to term with no complications.

By Agnes Kyotalengerire

Twenty-eight-year-old Tina Babirye, a resident of Kibale district, carried her second pregnancy to term with no complications.

Labour progressed well and she gave birth normally. However, the baby’s intestines were outside the abdomen. They were referred to Mulago Hospital where the baby’s condition was rectified.

Dr. John Ssekabira, a paediatric surgeon at Mulago Hospital, describes the condition as gastroschisis. He says gastroschisis is a birth defect of the abdominal wall, where the baby’s intestines stick outside of the body, through a hole beside the belly button.

He says the degree of the defect varies in children; the opening can be small or large  and sometimes other organs such as the stomach and liver, can also stick outside the body.

Causes

Though the cause is unknown, Dr. Nassar Kakembo, a pediatric surgeon at the hospital, says the defect occurs due to vascular accidents during the development of the foetus.

“There is early intrusion of the umbilical cord vein, which leaves a defect on the right side of the umbilicus (a scar where the umbilical cord was attached),” Kakembo explains.

As a result, the child is born with an opening, which allows the intestines and other organs to move outside the body. “Because the intestines are not covered in a protective sac and exposed to the amniotic fluid, the bowel can become irritated, causing it to shorten, twist or swell,” he adds.

How big is the problem?

Ssekabira says although the condition is rare, the chance of survival for children born with such defect in Uganda is minimal as opposed to developed countries where  children born with gastroschisis have 100% chances of survival.

He estimates that in the last 12 months, Mulago Hospital has received about 33 cases of babies born with their intestines outside the abdomen.

He attributes the condition to lack of facilities to care for the babies such as a well-equipped neonatal intensive care unit and inadequate parental nutrition.

“Only two babies have managed to survive in the last year. Taking care of a baby born with gastroschisis is costly that regular parents may not afford,” he adds.

Treatment

Ssekabira says treatment depends on severity of the condition. When the intestines are still in the membranes and not so much inflamed, surgery is done - the intestines are pushed back and the opening on the abdominal wall closed.

Even after the repair, infants with the birth defect usually have problems with feeding, digestion and absorption of nutrients. It is important that the child is supported on oxygen and fed through the total parental nutrition.

In a situation where facilities are lacking, Mary Gafana, a nursing officer at Mulago, says a silo plastic bag is used to cover the intestines.

The bag helps to reduce the inflammation of the intestines and keeps them warm. However, Gafana says often, management of the condition is compromised for most babies born upcountry because they do not know what to do.

They usually cover the intestines with gauze or pieces of cloth. “This damages the intestines further and by the time they are taken to hospital, the intestines are already infected and the children dehydrated, “she says.

Diagnosis

Dr. Daniel Zaake, a gynaecologist/ obstetrician at Mulago, says gastroschisis can be detected during pregnancy using a 3D ultra sound scan.

Can the defect be prevented?

Zaake says expectant mothers should take precautions of preventing foetal abnormalities. He says the first month is critical and it is when most vital organs are developing.

Zaake advises pregnant mothers to steer free of infections like rubella and syphilis as they may cause serious congenital abnormalities.

Alcohol consumption and taking certain drugs during pregnancy significantly increase the chances of abnormalities. Gafana urges expectant mothers to take a daily multivitamin with folic acid and avoid smoking.

'How I found out...'

Joyce Atai, mother of John Odong During pregnancy, I did not experience major problems other than severe vomiting in the first month. I delivered normally at Entebbe Hospital, but was shocked to see my baby with intestines out.

The doctors referred us to Mulago Hospital. The intestines were exposed without any membranes covering them.

The doctors said they could not do much and advised us to go back home. Despite the condition, the baby breastfeeds and passes stool normally.

Mary Namuli, 28

I did not do any ultra-sound scan while I was pregnant because I did not have any complications. I delivered at a clinic near my home in Masaka district.

However, I got shocked when a midwife said my baby had an abnormality in the stomach, as she handed him over to me. Seeing my baby’s intestines hanging out terrified me. We were referred to Mulago Hospital, but the baby died three days after admission.

Ponsiano Ayika, grandfather of late baby

Christine Onega’s second child was born with intestines out of the tummy, about a year ago at Nebbi Hospital. Both the baby and mother were referred to Mulago Hospital.

The baby was being given intravenous fluids, but passed away a few days after.

 

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