Emergency Pediatric Surgery for Rare Condition Saves Baby’s Life
July 31, 2024
When three-month-old Ethan Barnuevo Mija suddenly stopped breastfeeding and began vomiting repeatedly, his alarmed parents, Yessenia Mija and Johmar Barnuevo of Guttenberg, New Jersey, rushed him to a nearby urgent care center.
From there, they were quickly directed to Hackensack Meridian Palisades Medical Center in North Bergen. There, his care team determined he may have a blockage of his intestines and needed to go to Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center for very specialized pediatric surgical care.
Arriving by ambulance, two-month-old Ethan, was immediately seen by pediatric chief-of-surgery, Keith A. Kuenzler, M.D., who had already been notified and was arranging the appropriate studies with his colleagues in pediatric radiology.
Correcting a Life-threatening Condition
Further diagnostics revealed that Ethan had a rare intestinal malrotation, a birth defect that occurs when the intestines do not correctly or completely rotate into their normal, final position during development.
The condition puts a child at much higher risk of bowel “twisting” during normal digestion—clinically known as midgut volvulus, says Dr. Kuenzler. When it occurs, it typically happens in the first few weeks of life. It can also be life-threatening because it chokes off the blood supply to the intestines.
“This tends to occur more in patients with congenital heart diseases but is also found later in otherwise healthy babies who went home, and everything ‘looked perfect,’ as was the case with Ethan,” Dr. Kuenzler says.
A major and obvious symptom is the vomiting of bile, which tends to be a dark green color and implies an intestinal obstruction, and is never normal, says Dr. Kuenzler.
“Just like a stroke or heart attack, treating this condition is extremely time-sensitive, and since a baby can’t tell us what’s wrong, their ‘cry for help’ is the green-colored vomiting,” he says. “The time to act on this is usually measured in hours.”
Successful Procedure Returned Intestines to Normal
Ethan’s parents met Dr. Kuenzler, who explained what the surgery would involve and what it would accomplish. Seeing anyone receive high levels of emergency care for the first time can be intimidating, and Yessenia recalls being “very emotional” when discussing her baby’s condition.
“I asked the doctor to keep our baby safe, and he promised he would,” says Yessenia, who is a certified medical assistant in pediatric otolaryngology at Hackensack Meridian Medical Group in North Bergen.
The procedure was a success, and Dr. Kuenzler recalls breathing a sigh of relief when the dark purple-colored, twisted bowel returned to a healthy pink almost immediately upon untwisting it. “After surgery, the intestines that have been ‘shocked’ by the condition and the surgery then need a few days to recover and return to normal peristalsis,” he says. Peristalsis is a series of “automatic” wave-like muscle contractions that move food through the body’s digestive tract.
Dr. Kuenzler says that post-surgery, Ethan received intravenous fluids for hydration and to correct any electrolyte imbalances that occurred. “We also want to know that stomach fluids and bile are being processed and sent the proper direction ‘downstream,’” he says.
Ethan’s belly also changed from being distended and tight to being soft, and he was able to pass gas and have a normal bowel movement in his diaper again.
“Dr. Keith and the care team were with us whenever we needed any answers,” says Yessenia. “All the providers, including him, were really taking care of my baby like he was theirs.”
She says she could see a profound change the moment Ethan woke up, and a couple days later, she was even able to breastfeed him again. Ethan went home on day 4, once he was tolerating full feeds, Dr. Kuenzler says.
“Being able to avoid a catastrophe and restore Ethan to normal health makes my job the best one on the planet,” he says. “This is what brings us all back to work every day. Newborn surgery reminds me of the motto of the American Pediatric Surgical Association: We like to think we’re ‘Saving Lifetimes.’”
Next Steps & Resources
- Meet our source: Keith A. Kuenzler, M.D.
- To make an appointment with a pediatric general surgeon near you, call 800-822-8905 or visit our website.
- Learn more about pediatric general surgery at Hackensack Meridian Children’s Health.
The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.
