20-day-old preterm baby with rare gut disorder treated successfully

Bengaluru: Aninfant girl, when she was brought to Sakra World Hospital, Bengaluru, was only 20 days old and in critical stage with difficulty in breathing and unable to take her feeds. She weighed 1.76 kg with signs of a serious infection (sepsis) with a swollen belly. Her condition was urgently evaluated and treated under the expert care of Dr Anilkumar PL., Senior Consultant and Head of Paediatric Surgery, Sakra World Hospital, Bengaluru.

The baby girl was born prematurely at just 33 weeks through an emergency C-section at another hospital due to multiple complications, including breech position (baby not head-down), early water break (PPROM), and signs of distress.

On her second day, she started vomiting greenish fluid, a sign of a serious problem. Tests showed a rare and complex condition called Type 3b jejunal atresia, where part of her small intestine was blocked and had an unusual “Christmas tree” blood supply. During surgery, doctors also found that her intestines were not in the normal position, a condition known as malrotation.

Her condition was critical from the start, needing a ventilator due to trouble breathing and had surgery on her 2nd day. She was cared for in the NICU after surgery but by day 19, her belly became swollen again and she showed signs of infection (sepsis).

Dr. Anil shared, “The biggest risk was prematurity. During evaluation we found there were internal scars (adhesions) and unusual anatomy from the first surgery, severe infection (sepsis) caused by drug-resistant E. coli in the belly, stuck bowel loops, and a dead (gangrenous) part of the intestine. The damaged part was removed, followed by a bowel lengthening procedure called Heineke-Mikulicz, and reconnected the healthy bowel, and placed a feeding tube through the stomach.”

Colistin, a strong antibiotic, was started to fight the MDR infection.

“It was also difficult to get good IV access for fluids and medications. The bowel lengthening procedure (Heineke–Mikulicz) was very complex because the baby’s intestine was very thin and fragile. The “Christmas tree” shape of the mesentery (the tissue that carries blood to the bowel) made it riskier, as blood supply could be affected. Still, this procedure was necessary to increase the surface area for absorbing nutrients, since the baby had very little intestine left”, he added.

The outcome of the surgery was, only 30 cm of healthy small intestine remained, and the baby was diagnosed with short bowel syndrome. With careful monitoring and support from pediatric gastroenterologists, her feeding gradually improved. By 45 weeks, she was on full oral feeds.

She also received blood transfusions for anemia, and her vital organs and infection markers were closely tracked. Under strict care and hygiene, she recovered well and was discharged in June 2025, weighing 2.06 kg and feeding successfully.

Jejunal atresia and malrotation are issues that usually can’t be prevented. Premature babies, especially those born before 34 weeks, have weak intestines and are more at risk for feeding problems, infections, and conditions like NEC. In the infant girl case, she also had an infection from multi drug resistance (MDR). If a large part of the intestine is damaged, it may need to be removed, leading to short bowel syndrome, where the body can’t absorb enough nutrients.

The infant girl’s parents shared, “We had completely lost hope, but Dr. Anil saved our child. We are extremely happy to take our daughter back to health because of Sakra’s constant support and care.”