Babies turn yellow and become "little golden people"? Behind this lies a disease: "congenital biliary atresia" – a disease with a very high fatality rate in newborns, with early symptoms similar to jaundice. Recently, there was a 2-month-old "little golden man" from Jiangxi to Guangzhou, thousands of miles to seek medical treatment, and finally Wang Dejuan, chief physician of the Department of Pediatric Surgery of the Sixth Affiliated Hospital of Sun Yat-sen University, and a multidisciplinary team snatched the child's life from the hands of the god of death after six hours of difficult surgery.
Not jaundice, the "little golden man" is dying of an illness
After Xuanxuan from Jiangxi was born, after being born by caesarean section, he began to have yellowing of his skin and mucous membranes all over his body, and his stool was clay-colored, like a "little golden man". "I thought it was jaundice, basking in the sun, washing it with Chinese medicine, who knows but..." Xuan Xuan's mother recalled with palpitations. After more than 2 months, the symptoms of yellowing of the whole body did not decrease but deepened, from the face, trunk to the limbs, crying and refusing to eat the situation became more and more intense, Xuan Xuan's mother realized that something was wrong, to the local hospital for a check, found that jaundice related indicators were dozens of times higher than the normal value, liver function related indicators are also 7-8 times the normal value, the liver is in acute failure, life-threatening at any time! Xuanxuan's parents were not far away and were transferred to Professor Xiao Xin, director of the Department of Pediatrics of the Sixth Affiliated Hospital of Sun Yat-sen University.
After pediatric admission, improve the relevant examinations, liver CT suggests severe hepatitis with biliary atresia is likely, then immediately ask the hospital's pediatric surgery director Wang Dejuan chief physician consultation, combined with the child's signs and examination results, Wang Dejuan believes that the child's congenital biliary atresia is more likely, do not rule out infant stasis liver disease caused, combined with cytomegalovirus infection, it is recommended to immediately transfer to pediatric surgery.
Difficulties, can the "little golden man" catch up with the operation?
Wang Dejuan introduced that congenital biliary atresia surgery must be completed before the age of 3 months, otherwise the child's liver will be irreversibly damaged, such as not performing Kasai surgery or liver transplantation as soon as possible, the probability of premature death is very high. Xuan Xuan is young, the risk of surgery is extremely high, and postoperative complications may also lead to the inability to save xiao's life. In response to Xuanxuan's situation, the pediatric surgery team of the hospital invited pediatrics, hepatobiliary pancreatic and spleen surgery, radiology, nuclear medicine, ultrasound, pharmacy and other multidisciplinary consultations, "even if the diagnosis of biliary atresia is not terminal, there is still a one-third chance of getting better in Kasai surgery as soon as possible." Wang Dejuan gave hope to Xuanxuan's family, although they may still need liver transplants in the end, Xuanxuan's parents still want to seize the opportunity of this life.
Patiently tell the child's family about the process of surgery and the risks before and after surgery, indicating that the diagnosis has not yet been finally definitive, and surgery is both a treatment and an important step to confirm the diagnosis. After many communications, the children's family members chose to continue biliary exploration in the pediatric surgery department of the hospital. Pediatric surgery prepares laparoscopic hilar fibroblock resection and hepatic hilar-jejunal Roux-en-y anastomosis (Kasai surgery) for preoperative preparation.
Smooth surgery, the little golden man "finally "faded"!
The difficult surgery began, and the anesthesiologists skillfully and quickly performed tracheal intubation and arteriovenous puncture. The baby tissue is very fragile, the slightest mistake will cause great harm, Wang Dejuan's team chose to use laparoscopic technique, after the operation was confirmed as biliary atresia, according to the procedure of Kasai surgery, free hepatic portal blood vessels, hepatic portal fiber block removal, hepatic portal-jejunal anastomosis. The team members were highly focused throughout the process and completed the operation methodically over 6 hours.
During surgery
After the operation, Xuanxuan transferred to the pediatric department to continue symptomatic support treatment such as anti-infection, hormone, nursing, choleretic, vitamin supplementation, etc., the indicators of the liver gradually improved, the skin and mucous membranes of the whole body finally gradually faded, and the "little golden man" finally "faded" and was discharged from the hospital healthily!
The jaundice in the naked eye during the postoperative child's hospitalization is slightly reduced compared with before
Doctors caution against congenital biliary atresia
Wang Dejuan reminded: After the baby is born, if there is yellowing of the skin and mucous membranes all over the body, it needs attention. Neonatal physiological jaundice, mild is light yellow and limited to the face and neck, or spread to the trunk, the sclera can also fade after 2 to 3 days, and the skin color returns to normal on the 5th to 6th day; in severe cases, jaundice is first and hind feet, which can spread throughout the body, and the yellow staining time is up to 1 week or more, and some premature babies can last up to 4 weeks. However, if the whole body is yellow with stool clay color, please be sure to seek medical attention in time, be alert to the possibility of congenital biliary atresia, and find out as soon as possible to seize the three-month window period for treatment as soon as possible, which can reduce the damage to liver function and obtain a better prognosis.
Text, photo/ Guangzhou Daily, Xinhuacheng Reporter: Liang Chaoyi Correspondents: Jian Wenyang, Dai Xi'an, Zhang Yuanquan
Guangzhou Daily New Flower City Editor: He Xuehua