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Abstract: A 1-year-old boy was brought to the hospital by his parents for coughing and vomiting, and was examined by imaging for ventral cleft, a congenital abdominal wall dysplasia. Prompt admission was followed by abdominal cleft repair, after which the patient’s abdominal cleft gap was repaired and symptoms such as coughing, shortness of breath and vomiting disappeared. However, since this disease is a congenital anomaly, there is a certain risk of recurrence, so parents are advised to pay more attention to observe their children for signs of recurrence.
Basic information】Male, 1 year old
Disease Type】Abdominal cleft
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of Consultation】February 2021
Treatment plan】Abdominal cleft repair
Treatment Period】3 days of admission and 2 months of re-examination
Results】The patient’s abdominal fissure was repaired and the cough, shortness of breath and vomiting disappeared.
I. Initial consultation
On Sunday morning, Ms. Wang brought her child, who had just turned 1 year old, to the clinic with a persistent intermittent cough with significant wheezing, and seemed to have difficulty breathing, especially when inhaling. Ms. Wang told me that her child had been crying a lot recently, and her bowel movements were very abnormal, often not defecating for 1-2 days in a row, and the feces she passed were more smelly than before, and she had vomited after eating yesterday and today, and cried and said she was not feeling well after vomiting. According to Ms. Wang’s description, imaging was performed on her child. X-ray and gastrointestinal imaging suggested that part of the ileum and colon were located in the left thoracic cavity, and ultrasonography showed a “W”-shaped left and right diaphragm in the transverse section of the upper abdomen, with a narrow band of strong echogenicity, smooth and continuous echogenicity, almost overlapping with the strong echogenicity of the lower border of both lungs, with no gap. The upper abdominal scan showed upward shift of the lower lung border, interrupted diaphragm echogenicity, and herniated contents were seen between the diaphragm and the lower lung border. After comprehensive examination, the diagnosis was abdominal cleft, i.e. congenital abdominal wall dysplasia.
(X-ray: A large hyperdense shadow was seen on the left side of the chest, which contained intestinal gas shadow, and the left diaphragmatic surface was poorly displayed.)
(Gastrointestinal tract imaging: diagnosis of abdominal cleft)
II. Treatment history
After a clear diagnosis, the patient was admitted to the hospital promptly, and after full communication with the parents, they agreed to undergo surgery. After preoperative examination, there were no contraindications to surgery, and a combined thoracoscopic and laparoscopic operation was performed to repair the defective diaphragm by folding the diaphragm in the longitudinal direction and returning the intestinal canal herniated into the patient’s thoracic cavity to its normal position in the abdominal cavity. The patient’s vital signs were closely monitored after the operation, and the patient was discharged after 3 days of hospitalization with no abnormalities in the indicators. The parents were instructed to bring the patient for a review every 2 months.
III. Treatment effect
After timely and standardized surgical treatment, the patient recovered well without leading to high-risk complications such as intestinal necrosis and pulmonary hypertension, and without causing serious gastrointestinal disorders such as intestinal bleeding, intestinal perforation and gastric ulcer. Through timely abdominal cleft repair, the patient’s intestine that had displaced into the left thoracic cavity was reset into the abdominal cavity, and then the weak defect in the patient’s left diaphragm was repaired and fixed with sutures. After the operation, the patient’s abdominal fissure was repaired, breathing returned to normal, and symptoms such as vomiting, shortness of breath and abnormal defecation disappeared.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but the patient has many precautions to take in the subsequent treatment process.
1, every 2 months after discharge from the hospital should be reviewed on time, and if any discomfort in the chest and abdomen occurs during the follow-up period should be checked immediately to avoid delays leading to delay in the diagnosis and treatment of the disease.
2, patients are advised to eat more high-calorie, high-protein, vitamin-rich foods after surgery, such as chicken, fish, milk, soybeans, eggs, etc., reduce fat intake, drink more water, and eat more fresh fruits and vegetables.
3, patients in the post-operative gastrointestinal tract is still in an unstable state, so they should strictly follow the doctor’s instructions to take medication, not to stop or change medication, or change the dosage and frequency of medication on their own.
4. Parents should pay attention to the oral hygiene of patients, do a good job of oral cleaning and brush teeth on time to avoid secondary gastrointestinal infections.
V. Personal insight
Abdominal cleft is a congenital malformation, just like the patient in this paper, whose abdominal cleft is caused by congenital factors, so there is a certain probability of recurrence in the later stage. Parents need to maintain a positive and good attitude, usually strengthen the care and attention of their children, and review them regularly. In addition, parents should pay attention to their child’s weight control, because obesity increases the probability of recurrence of the disease.