Bangladesh: Three babies, one problem

22 December 2017

Ian is in Bangladesh, where MSF / Doctors Without Borders is providing medical care to Rohingya refugees. Since August 2017, over 620,000 Rohingya people have arrived in Bangladesh, fleeing violence in neighbouring Myanmar. 

Sometimes bowels stop moving. Peristalsis, the rhythmical squeezing of muscles in the gut wall, quits. This results in a swollen, quiet abdomen. No farting. No faeces. There are many different causes, including anything which insults the intestines, such as recent surgery.

Paralytic Ileus is not that common in babies, but when it occurs it is alarming. Like waiting for buses, you see none for ages, then three come along at once.

The first baby had been suffering from diarrhoea for a few days, but had not passed stools for 24 hours and the belly was tense and distended.

"What do you think, doctor?" asked one of the national doctors.

"Let's take a bit more history," I advised.

It transpired that the mother had gone to a local "pharmacy" to buy medicine to stop the diarrhoea. She had inappropriately given it to her baby. It had worked too well, and the bowels had stopped moving.

A small, warm, soapy enema produced a good result and the baby was much less irritable.

Image shows a crying baby

One of the babies with paralytic ileus at the clinic. Photo: Ian Cross / MSF

The next infant was brought in extremis. When the nurse inserted a venous catheter, the blood looked very thin. He had less than 20% of the haemoglobin of a normal baby of his age. He was resuscitated and given a blood transfusion. The next morning, the baby looked much better, more lively, but he had a swollen, silent abdomen. I immediately thought that the intestine could have been damaged by the severe anaemia with lack of oxygen. We stopped oral fluids, giving them intravenously instead, and inserted a naso-gastric tube.

On the ward round this morning, his mother gestured to me. She indignantly showed me a brown smear of faeces on her wrap saying it was not the usual yellow colour. I didn't care. The child's bowels were moving again and the distended tummy had reduced in size. She could always wash her wrap.

He must be a resilient little chap

The last baby was a newborn. A health worker in another clinic referred the baby to the hospital because he had not passed any waste matter (meconium) since birth, 48 hours ago. The baby did not have a paralytic ileus. The anus had not formed correctly during development. The mortality rate for these babies climbs steeply after 24 hours so we needed to refer the child immediately for surgery. In the operating theatre, the surgeon saw that the large intestine had already perforated. He patched this up and created a colostomy.

It is common for children with one congenital abnormality to have another. This baby also had a hole in the heart between the ventricles. We also discovered that his father had been shot in Rakhine a few months ago.

He is doing well after surgery, so he must be a resilient little chap. With this dreadful start to his life, he will have to be.

 

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