Bengaluru (Karnataka) [India], May 21: A 33-week pregnant lady with foetal distress was admitted and delivered a preterm baby in a private hospital. But, the newborn started facing breathing difficulty, and was immediately referred to Sakra World Hospital for further diagnosis. The infant weighed only 2.18 kg at birth.
The breathing difficulty was due to a huge swelling inside the abdomen, which was compressing the lungs. The baby was put on ventilator support, and on evaluation, it was found to be an intra-abdominal tumour, but the origin of it was not clear. Therefore, Dr. Anil Kumar Pura Lingegowda, HOD & Senior Consultant – Paediatric Surgery; Dr. Shruthi Reddy, Consultant Hepato-Biliary Pancreatic and Liver Transplant Surgeon; Dr Shishir Chandrashekhar, Director & HOD – Anaesthesia & OT Management; and, Dr. Shivakumar Sambargi, Senior Consultant- Pediatrics & Neonatology of Sakra World Hospital, Bengaluru, decided to perform surgery on the baby to remove the swelling because of its pressure effect on vital organs.
Dr. Anil shared, “The swelling was arising from the left lobe of the liver and occupying 70% of the abdominal cavity, that is, the size of the tumour was 10*8*7 cm. But the challenge was to perform resection of the tumor, which was very risky for a 3-day-old, 2 kg preterm baby because of bleeding and low weight of the baby.”
Dr. Anil added, “The intra-operative phase posed a significant challenge, particularly due to the need for massive blood transfusion, which was managed by Dr. Shishir Chandrashekhar and his team. Additionally, the tumor resection from the liver was successfully performed with the expertise of liver transplant surgeon Dr. Shruti Reddy.”
The post-operative period was equally challenging, requiring careful management to maintain homeostasis. The neonatology team, led by Dr. Shivkumar Sambargi, provided exceptional care to save the child.
Dr. Shivakumar Sambargi, Senior Consultant- Pediatrics & Neonatology, shared, “The tumor was identified as a mesenchymal hamartoma, a rare occurrence in neonates, with complete excision being the definitive cure. This is usually discovered in infancy, mesenchymal hamartoma of the liver (MHL) is a rare, benign developing tumour in infants that has a mixture of solid and cystic areas. After infantile haemangioma, it is the second most frequent benign liver tumour in children.”
Dr Shishir Chandrashekhar, Director & HOD – Anaesthesia & OT Management, shared, “Managing anesthesia and blood transfusion in such a tiny newborn was extremely challenging, but our team ensured the baby remained stable throughout the procedure.”
“Notably, there are no reported cases worldwide of liver tumor resection in a 3-day-old preterm baby weighing just 2 kg. And the operating process should always be carried out in a well-equipped centre under expert supervision,” said Dr. Anil.
Dr. Shruthi Reddy, Consultant Hepato-Biliary Pancreatic and Liver Transplant Surgeon, shared, “Liver surgeries are no longer formidable like it was a few decades ago. Tumour resections or transplants during extremes of age like this newborn baby or an elderly person are much safer now with the recent advances in surgical technology and techniques. Caregivers should keep an open mind if such surgeries are offered by an expert. The trust afforded in us by the parents of this baby enabled us to save the baby’s life”.
Ms. Sunitha (Name Changed) shared, “I’m truly grateful to Dr. Anil and team for curing my baby. He explained the case and procedure, which made us have faith in him, and now my baby is recovering healthy.”
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