Famous Among Top Surgeons in the 90s

Chapter 2255: Chapter 2255: Hard to Detect

How many prenatal checkups were conducted and how much money was spent, only to end up like this?!

In the minds of the family, they often hear about pregnant women undergoing prenatal checkups and finding out the fetus has a problem, with doctors suggesting a termination. Prenatal checkups should fully identify any fetal health issues.

This is the reason for Doctor Peng’s anxious sighs. If he goes out and discusses this matter with the patient’s family now, it’s likely to result in an argument. The child’s father had already questioned whether the medical staff were negligent.

The family is expected to not only challenge the obstetricians for failing to diagnose the fetal illness beforehand but also criticize the neonatologists for taking twenty hours to realize their child has a condition.

Doctor Wang’s mood isn’t much better than Doctor Peng’s, but as a doctor, he must acknowledge reality: "This condition in the child is not easily detectable."

"Is this esophageal atresia?" Doctor Peng asked a colleague.

In neonatology, the common tracheal fistula isn’t a bronchopleural fistula; rather, it’s a relatively rare disease known as esophageal atresia.

The child’s "swollen belly" is actually due to pneumoperitoneum, which is caused by gas entering the gastrointestinal tract, leading to abdominal swelling.

Where did the gas in the gastrointestinal tract come from?

The amount of air inhaled into the digestive tract through the mouth in a normal person is minimal, not enough to cause abdominal swelling. The air inhaled by a person primarily goes through the nose to the lungs for gas exchange.

Some clinical anomalies are due to anatomical differences between the patient’s body structure and a normal human body. If the air doesn’t follow the normal route to the lungs but goes to the abnormal path of the digestive tract, it may result in pneumoperitoneum.

The abnormal path is what Student Xie referred to as the fistula. A fistulous tract has formed between the child’s trachea and digestive tract, and the air that should have been inhaled into the lungs has gone into the digestive tract. Anatomically speaking, the organ adjacent to the trachea in the digestive system is the esophagus, which is the most likely location for an abnormal fistulous tract to occur. Indeed, this is what has happened, known as a tracheoesophageal fistula.

Tracheoesophageal fistula can be considered a symptom of a result. The causes can include trauma, infection, etc. In neonatology, doctors need to pay attention and rule out the possibility of congenital disease.

For a newborn who has received a good score at birth, trauma and external infection are indeed less likely, while congenital causes are more probable. Among neonatal congenital diseases that cause tracheoesophageal fistula, Doctor Peng mentioned congenital esophageal atresia as the most common reason.

Doctor Peng continued, "With esophageal atresia, the child shouldn’t be able to ingest milk."

The focus shifts back to why the neonatology department didn’t notice any abnormalities during feeding?

Esophageal atresia, as the name suggests, is when the esophagus is closed off, meaning one end of the esophagus as a digestive tract pipeline is terminated. To put it more simply and vividly, the esophagus is like a faucet pipe that hasn’t been connected to the sink (stomach). If you were to dissect the bodies of affected children, you would clearly see that the esophagus and stomach are not connected, with the esophagus sealing off itself. A segment where the digestive tract pipeline was supposed to be continuous is missing.

Such an odd condition—why does the esophagus close off by itself? When we say this disease is congenital, it indicates poor development of the fetus within the mother’s body. Tracing back to the various causes of the child’s congenital disease, many factors exist, such as exposure to a polluted environment during the mother’s pregnancy, or chromosomal abnormalities in the parents causing abnormal fetal development. These causes, among others, are currently extremely difficult for medicine to precisely investigate.