On the afternoon of March 14, Cho Ray Hospital announced that it had successfully treated a pregnant woman (21 years old, living in Dong Thap ) with congenital diaphragmatic hernia, causing the organs in the peritoneal cavity to enter the chest through the defect behind the diaphragm, causing compression of the lungs.
This is a rare disease. According to medical literature, over the past 100 years, the world has recorded only about 160 cases.
The patient was 33 weeks pregnant and was admitted to the hospital with respiratory failure and hypotension, which threatened the lives of the mother and fetus. Immediately, the hospital activated the red alert procedure for interdisciplinary consultation (Digestive Surgery, Thoracic Surgery, Anesthesia and Resuscitation...) and in collaboration with Hung Vuong Hospital, which determined that the patient had a complete hernia of the stomach, the entire small intestine and transverse colon, spleen, and pancreas into the left lung.
The consultation team decided to use brain and lung support drugs to ensure the baby has better respiratory progress as well as reduce future sequelae, and place a gastric decompression tube to improve the ischemic stiffness of the hernia. At the same time, use high doses of strong antibiotics to support the pregnant woman's lung infection.
The patient underwent emergency surgery that night, the surgery lasted more than 4 hours, completely by laparoscopic surgery to limit stimulation to the uterus to preserve the fetus. The team successfully decompressed the diaphragmatic hernia, the entire stomach, the entire small intestine, the colon, spleen and tail of the pancreas, the herniated organs showed no signs of necrosis, only a part of the front of the stomach was bruised and was sutured, the left diaphragm was restored and a double-sided anti-adhesive mesh was placed to prevent recurrence, and a pleural drain was placed to support the left lung.
After surgery, the patient was transferred to the Emergency Resuscitation Department in a state of severe respiratory failure, requiring intubation, the fetus showed signs of fetal distress after 36 hours. Immediately, Cho Ray Hospital consulted with Hung Vuong Hospital and decided to perform a cesarean section. The surgery took place within 40 minutes, successfully saving the life of a 2kg baby girl, who was transferred to Hung Vuong Hospital for monitoring. After a day, the mother's respiratory condition improved significantly, her lungs expanded well, the endotracheal tube could be removed and her vital signs had recovered well. After 6 days of treatment, the patient was discharged from the hospital.
Master-Doctor Tran Vu Duc, Department of Digestive Surgery, Cho Ray Hospital said that this is a rare case of congenital diaphragmatic hernia and is also the first time it has been seen in a pregnant woman at Cho Ray Hospital. During the consultation, the team was very hesitant because if these hernias are left for a long time, the possibility of necrosis will be very high and it will be very difficult to save the mother. On the contrary, if surgery is performed immediately to save the mother's life, it will be difficult to keep the fetus. After urgent consultation with many specialties, at the same time, coordinating with Hung Vuong Hospital to come up with the best plan as well as to prepare for possible situations. Therefore, saving both mother and child is the luck and efforts of the teams of the two hospitals.
According to Dr. Tran Thanh Linh, Head of the Emergency Resuscitation Department at Cho Ray Hospital, the biggest difficulty in the early stages after surgery is that in addition to optimal resuscitation to ensure the life of the pregnant woman, the team must also protect the fetus from being affected by the mother's respiratory failure. At the same time, closely monitor and detect fetal failure early to decide when to terminate the pregnancy in time to save the baby.
“Pregnant women who have unusual signs such as difficulty breathing, poor appetite, vomiting or symptoms related to stomach and intestinal diseases need to go to a medical facility, especially a relatively specialized medical facility, to proactively check their pregnancy health and detect early and promptly,” Dr. Tran Thanh Linh recommends.
THANH SON
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